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DISEASES OF THE EAR, 














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AN ESSAY 



'I8EASES OF THE INTERNAL EAR, 



By J. A. SAISSY, M. D. 



MEMBER OF THE FOYAL ACADEMY OF SCIENCES, LITERATURE AND ARTS IN LYONS, 

FELLOW OF THE AGRICULTURAL AND MEDICAL SOCIETY OF THE SAME CITY, 

OF THE ACADEMIES OF TURIN, ROUEN, AND DIJON, 

AND OF THE MEDICAL SOCIETIES OF BORDEAUX, ORLEANS, MARSEILLES, ETC. 



IONOURED WITH A PREMIUM BY THE MEDICAL SOCrETY OF BORDEAUX 
AND SINCE ENLARGED BY THE AUTHOR. 



TR+WSLATED FROM THE FRENCH, BY 

NATHAN R. SMITH, M. D 

PROFESSOR OF SURGERY IN THE UNIVERSITY OF MARYLAND, 

WITH A SUPPLEMENT ON 

DISEASES OF THE EXTEMAL EAR, 

BY THE TRANSLATOR. 



W. 



*» Baltimore: 

PUBLISHED BY HATCH & DUNNING. 
1829. 



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DISTRICT OF MARYLAND, TO WIT*. 

BE IT REMEMBERED, That on the tenth day of September, in the fifty-fourth year 
of the Independence of the United States of America, Hatch & Dunning, of the said 
district, have deposited i^tbis office, the title of a book, the right whereof they claim as 
proprietors, in the words following, to wit: 

"An Essay on the Diseases of the Internal Ear, by J. A. Saissy, M. D. member of the 
Royal Academy of Sciences, Literature and Arts in Lyons, fellow of the Agricultural and 
Medical Society of the same city, of the Academies of Turin, Rouen and Dijou, and of 
the Medical Societies of Bordeaux, Orleans, Marseilles, &c. A work honoured with a 
premium by the Medical Society of Bordeaux, and since enlarged by the Author Trans- 
lated from the French by Nathan R Smith, M. D. Professor of Surgery in the University 
of Maryland; with a supplement on Diseases of the External Ear, by the Translator." 

In conformity to the Act of the Congress of the United States, entitled, "An Act for the 
encouragement of learning, by securing the copies of maps, charts, and books, to the 
authors and proprietors of such copies, during the times therein mentioned;" and also to 
the act, entitled "An Act supplementary to the act, entitled 'An act for the encouragement 
of learning, by securing the copies of maps, charts and books, to the authors and proprie- 
tors of such copies during the times therein mentioned:' and extending the benefits there- 
of to the arts of designing, engraving, and etching historical and other prints." 

PHILIP MOORE, 
Clerk of the District of Maryland. 
BAILEY <fc FKANCIS, PRINT. 



* 



PREFACE, 



BY THE TRANSLATOR 



A concise manual on the diseases of the ear is an acknowl- 
edged desideratum in our medical literature. No sufficient 
work on this subject has ever been issued from the American 
press. With a view to supply this deficiency, I have trans- 
lated the following pages from the French of Saissy. The 
work first appeared in 1819, as an article of the Dictionnaire 
des Sciences Medicales. It was subsequently corrected and 
enlarged by its author, and after his death was published in 
1827 by his friend Montain, with notes by Dr. Th. Perrin. 

In this valuable work the author has, with industrious re- 
search, availed himself of all the previous improvements in 
this department of surgery. It embodies the excellencies of 
Saunders, Cooper, Leschevin, Maunoir, Itard, and Alard, and 
I believe there will be found in the accompanying notes nearly 
all the valuable facts which have been ascertained in relation 
to this subject since the death of Saissy. 

The work, I understand, is highly esteemed in France, and 
the practice recommended in it has been attended with very- 
encouraging success. 

The attention of the reader will be particularly occupied 
with Saissy's excellent method of injecting the ear through 
the eustachian tube. We very well know how frequently the 
external ear is obstructed by its own secretions, free as is 
their egress from this cavity. The internal ear is also lined 
with a membrane which furnishes an excrcmentitious fluid. 



th 



6 

It can escape only by the narrow channel of the eustachian 
tube. How frequently then must it be delayed in the cavity 
of the tympanum and mastoid cells, giving rise to any degree 
of mischief. 

How often do we see, covering the body of the foetus at 
birth, a concrete, white, mucous substance secreted by the 
skin or deposited from the liquor amnii. This fluid also at 
birth fills the cavity of the tympanum, and we must neces- 
sarily infer that this deposit is present there also, and that in 
many instances it may be the cause of congenital deafness. 

To render the work more complete and useful to the medi- 
cal pupil, I have added a brief supplement on the diseases of the 
external ear. On this score, however, I claim nothing, as my 
addition is made up of common-place principles and precepts 
subjoined merely for the purpose named above. I have, it is 
true, for perforating the tympanum, devised a new instrument 
which I trust will be found useful. N. R. S. 



A 



Hearing is one of the important functions of the life of re- 
lation; its deprivation is, to man, a source of suffering, and its 
exercise one of great enjoyment. The organ designed for the 
performance of this important function is exposed, as are the 
other senses, to numerous diseases; its painful affections are 
often excruciating; its frequent inflammations impede and some- 
times destroy its functions, and its organic lessions diminish or 
pervert the power of perception. The affections of this im- 
portant sense are even imparted to that noble faculty of man — 
the power of communicating his ideas by speech. The voice 
is affected simultaneously with hearing, and the loss of the lat- 
ter faculty often induces imperfections of speech, or even its 
entire loss. Thus, as Buffon has observed, hearing is far more 
necessary to man than to other animals, because, in the latter, 
this sense is but a passive property, capable merely of trans- 
mitting external impressions. In man, it is not a mere passive 
endowment, but a faculty which becomes active through the 
medium of the organs of speech. 

Persuaded of the importance of this sense, to the happiness 
of man, Dr. Saissy devoted a part of his life to the study of 
its anatomy, its physiology, its diseases, and their treatment. 
Encouraged by his experience and the success of his practice, 
he was about to publish his work, when death snatched him 
from the science which he honoured and which he cultivated 
with so much success. Satisfied of the excellence of the work, 
a witness of the frequent success of the author, I now fulfil his 
intentions and those of his family, in presenting the public with 



t 



8 

this excellent treatise on the Diseases of the Ear, which work 
I shall premise with a biographic notice. 

Doctor Th. Perrin, physician to the Institution of Deaf- 
Mutes, at Lyons, and who is particularly occupied with dis- 
eases of the ear, has kindly offered to aid me with his experi- 
ence in this interesting department of Therapeutics. He has 
added to the work many notes, and a lithographic sketch from 
nature, representing the sound of Dr. Saissy, in its relation to 
the nasal cavities and the eustachian tube. 



M 



BIOGRAPHIC NOTICE 



JEAN ANTOINE SAISSY. 



W 



It is the usual reward of the man of modest merit, that 
the respectful remembrance of him, which survives the tomb, 
attaches itself to his name, and is associated with his works; 
and in placing over his cemetery the ensigns of immortal- 
ity, posterity delights to imitate the man, by whose works 
they are enlightened and enriched. Such are the sentiments 
which have suggested this memoir of the life and labours of 
Dr. Saissy, a physician of distinguished modesty, and whose 

hole life was devoted to the cultivation of science and the 
relief of mankind. 

Jean Antoine Saissy was born, February 2d, 1756, at Mon- 
gins, near Grasses, in the fine climate of Provence. His 
father, a wealthy planter, offered his son no other occupation 
than that to which he himself was devoted; but he allowed 
him that agreeable freedom which cherishes good or evil in- 
clinations, especially in those mild climates, where the pro- 
pensities have all the ardor of passion. A few medical books 
fell into the hands of Antoine Saissy, and he read them with 
avidity. They determined his future avocation, and nothing 
could afterwards divert him from a course, to which he seem- 
ed to be impelled. His father yields to his entreaties. An- 
toine Saissy desires to seek the highest sources of instruc- 
tion — he repairs to Paris, and there cultivates, at once, all 
2 




10 

the departments of the science to which he had devoted him- 
self. But already a part of his life had been spent in the 
fields, and at twenty two years of age, he possessed no other 
education than that which he had acquired from the teacher 
of the village, and from such books as he could procure. In 
this Saissy gives us a striking example of the strength of 
resolution, and of native propensity. Like many other learn- 
ed men, who honour science and the age, he sought to repair, 
by industry, the deficiencies of the past. He applied himself 
with care to the study of all the rules and principles of those 
languages which he had before neglected, because, till then, 
he had had no use for any other language than that of nature 
and necessity, to express his ardent thoughts. Nevertheless, 
having, for a long time, heard and spoken the language of 
Provence, he could not divest himself of an accent which gave 
his speech an appearance of abruptness, and at times a hur- 
ried expression, indicative of the activity of his mind, and 
the sprightliness of his fancy. 

Antoine Saissy remained several years in Paris, and attend- 
ed with zeal the most distinguished professors, from 1777, to 
1782. His certificates are honoured with the names and en- 
comiums of Louis, Chopart, Perihle, Pelletan, Hevin, Las- 
sus, Ferrand, &c. All declare his ardour in the pursuit of 
science, and many speak of the honours which he achieved. 

In 1783, Saissy was received, by election, as house-surgeon 
of the great Hotel-Dieu of Lyons, and, at the same time, en- 
tered there upon the discharge of his duties. He left it in 
1786, and obtained from the authorities of the Hopital ge- 
neral de Notre-Dame-de-Pitie du pont du Rhone et grand 
Hotel-Dieu de Lyon certificates which declare his complete 
qualifications, and the honourable manner in which he had 
discharged the duties of house-surgeon and those of demon- 
stator of the course of anatomy and surgery. 






f 



11 

A lively imagination, some degree of ambition, and vigor- 
ous health, induced Antoine Saissy to accept proposals from 
the Royal African Company. On leaving the Hotel-Dieu he 
went, as physician and surgeon major, to the Factories esta- 
blished on the coast of Barbary. Although time had not per- 
fected the judgment of our professional brother, he perceived 
how injurious was the violent mode of practice pursued by 
the physicians of those countries. He discovered that they 
treated inflammations with stimulants, and that they kindled 
rather than extinguished them. He administered mild re- 
medies, and combatted inflammation, rather than directed 
occult remedies against imagined diseases. He was fortunate 
because he was wise, and his reputation even entered the wall 
of the seraglio. The Dey of Constantinople took him to 
his residence, to attend one of his children, which he had the 
happiness to rescue from near and certain death. That prince 
made every exertion to attach him to himself, and to fix him 
permanently in his vicinity, but he knew the result of these 
splendid favours; he knew what violence often succeeded the 
extravagant complaisance of those tyrants,* who are as igno- 
rant as they are proud, generous and ungrateful by turns, at 
one time prodigal in benefactions, and at another in horrible 
tortures. Antoine Saissy was desirous of avoiding the 
chances of such diverse fortunes, and he was recalled by his 
recollection of happy France, where barbarian ignorance 
reigns not over an enslaved people. 

Soon after his return to France, on the 26th of June, 
17 9S, Saissy defended, before the Chirurgical College of Ly- 
ons, a thesis on the Inoculation of the Small-Pox, and was made 
a member of the college. In the course of the same year, he 

* A journal recently announced that the Sultan had commanded his 
chief physician to cure his Grand Vizier, on pain of death. M. T. 



k 



IB 

was made Doctor of Medicine, by the University de Valence, 
a title which it was necessary for him to obtain, in order to 
practice all the branches of the healing art. It was the same 
year that Dr. Saissy married the daughter of M. Thenance, a 
distinguished practitioner of Lyons, to whom We are indebted 
for some important observations on Parturition, and for the 
forceps which bear his name. 

Dr. Saissy was employed in every branch of the healing 
art; but, after the example of his father-in-law, he devoted 
himself more especially to the practice of midwifery, an im- 
portant branch of medicine, which, in our city, is not, as in 
many others, restricted to the mechanical routine of the ac- 
coucheur. Generally, whatever distinguished physician may 
have devoted himself to the practice of midwifery, extends 
his pursuits, and passes from the department of midwifery to 
that of physick. This was the reputable mode which Dr. 
Saissy adopted. It was by a practice thus laborious, that our 
estimable associate qualified himself to achieve one of the most 
honourable prizes decreed by the first Academy of Europe. 

An important question was proposed by the Institute, in re- 
lation to the nature and causes of the phenomena exhibited by 
hybernating animals during the winter. The question was im- 
portant, and required protracted and laborious research. It 
was necessary to surprise nature in the very act — it was ne- 
cessary, so to speak, to winter with dormice, marmottes, and 
bats. Our professional brother was nothing discouraged by 
the difficulties of the undertaking; he regarded nothing but the 
pleasure of informing himself — of eliciting the secrets of na- 
ture, and the honour of shedding light upon the natural sci- 
ences. His wish was accomplished, and his work was pre- 
ferred by choice of the learned of Europe. On the 4th of 
January, 1828, the Institute awarded to him the prize; a dis- 
tinguished and grateful recompense, as honourable to the body 






13 



which gave it, as to the talent which knew how to deserve it. 
Dr. Saissy soon published his work, to which a discerning 
public rendered the same respect as did the Institute. • 

In 1810, he communicated to the Institute a valuable essay 
on Croup. That disease was at that time altogether new, and 
then first appeared in the medical horizon. Many believed 
that, till then, it had been confounded with other diseases, and 
especially with Cynanche Tonsillaris. That disease, which 
had for a long time destroyed with impunity, blighted the 
hopes of the throne, and awakened the attention of men of 
science and also of the government. Numerous memoirs upon 
Croup appeared, and Dr. Saissy was one of the first to devote 
his attention to the subject. By exciting expectoration, he had 
obtained the morbid membrane, which is formed in croup. 

i Professors Cuvier, Halle, and Pinel, made a report highly 
honourable to the work. 
All the sciences were cultivated by Dr. Saissy with success. 
We have seen him obtain prizes on important topics in natural 
history, and discuss, with reputation, questions in medical 
science. We shall see him with equal advantage in another field. 
Natural Philosophy and Chemistry received his devoted atten- 
tion. In 1811, he presented the Institute with an interesting 
memoir on the extrication of light, by the condensation of gas. 
He proved, by experiments, made in association with the 
learned Professors Molets and Reymond, that the disengage- 
ment of light is owing to oxygen, and that the experiment 
made upon other gases, when pure, does not produce it. "The 
' property of producing heat belongs," says M. Thenard, "to 
all the gases; but, according to Saissy, the property of dis- 
engaging light, by these means, belongs to none but oxygen, 
chlorine, and air. Oxygen possesses it in a much higher de- 
gree than chlorine, and this last in a much higher degree than 
air." "What is very certain," Professor Thenard again re- 



it 



14 

marks, "is that, by compression, much more light is extricated 
from oxygen than from air, and that it is not extricated at all 
from carbonic acid gas, azote, hydrogen, &c." Dr. Saissy has, 
therefore, established an important fact. It is rendering him 
sufficient honour to quote the approbation of Professor The- 
nard, and that of the Institute. 

During the twelve last years of his life, he was particularly 
occupied with diseases of the ear, and the better to learn the 
morbid changes of that important organ, he studied its anato- 
my and physiology with great care. For that minute investi- 
gation, he tasked the same patience and perseverance which 
had enabled him to succeed in his work on hybernating ani- 
mals. Whoever knew Dr. Saissy, could not conceive, how so 
ardent an imagination could confine itself to subjects which re- 
quired the exercise of so much patience. I will not follow the 
author through the details of the excellent work which we are 
about to publish; I will merely observe that the whole is the 
result of experience and observation — that it was with the 
knife in hand that he demonstrated the anatomy of the ear, and 
that it was by frequent success that he has proved the excel- 
lence of his practice. Our distinguished associate learned to 
discover, with peculiar sagacity, the morbid changes of the 
eustachian tubes, and acquired singular dexterity in sounding 
them, and in conveying his injections into them. If his treat- 
ment is not altogether new, his mode of procedure is so. His 
canulae and sounds are contrived in the most convenient man- 
ner, to enter, through the nasal cavities, the expansion of the 
eustachian tube; and his mode of doing this is his own. Dr. 
Saissy addressed a fragment of the work to the Medical So- 
ciety of Bordeaux, in reply to a question proposed by that so- 
ciety, on the diseases of the ear, and he again received an 
honourable award. 

He has written many important articles in the Dictionnaire 
des Sciences Medicales. The Medical Society of Lyons pos- 



15 

sesses, in its archives, a great many observations which were 
communicated by Doctor Saissy. During* the last year of his 
life, and when he had already contracted the germ of the 
disease which was to destroy him, he read, at various times, 
different parts of his work, which he submitted, with his usual 
modesty, to the censure or approbation of his colleagues. 

Doctor Saissy was connected with most of the learned so- 
cieties; he was a member of the Academy of Lyons — of the 
Agricultural and Medical Societies of the same place — of the 
Academies of Turin, Rouen, Dijon, and of the Medical Socie- 
ties of Bordeaux, Orleans, Marseilles, &c. 

In the decline of life, or during the pains of a tedious and 
irremediable disease, man is often led back, by recollection, to 
those regions which witnessed his childhood. The hope of 
once more beholding them is grateful to his imagination, and 
he seems to derive new energy from reviewing those dear and 
delightful retreats, where he knew no ambition, nor the bitter 
disappointments of life. Thus Dr. Saissy, the last year of his 
life, believed that he should be able to regain his health, under 
the fine sky of Provence, which he had so long since forsaken. 
Sustained by hope, and the care of his children, he undertook 
the desired journey; but, vain hope! — the disease increased; 
hydrothorax supervened — a new desire possessed him, of 
coming to terminate his career in his adopted country — in the 
midst of his family and friends, where his labours had obtained 
for him more honour than emolument. 

He arrived there on the 5th of March, 1822, no longer sus- 
tained by hope, but solaced by filial piety; and, two days after, 
he expired with the resignation of a good man. 

MONTAIN, 

Secretary General of the Medical Society, Professor of 

Therapeutics, Ex-Surgeon in Chief of the Hospital. 



1 



.1 



INTRODUCTION. 






Among the diseases which afflict the human species, those 
of the internal ear require, on the part of the profession, new- 
efforts and new researches. The works of Duverney, Val- 
salva, Morgagni, &c. &c. have, it is true, thrown some light 
upon this subject, but what topic is there on which there is 
left nothing more to be desired ? 

More recently those distinguished men, Cotunnus, Meckel, 
Scarpa and Compared, have enriched the science with their 
valuable discoveries — the first, by demonstrating that the laby- 
rinth is filled with a thin fluid, instead of air supposed to be 
contained in it — the second, by giving a more true and definite 
description of the" parts which line the labyrinth, and espe- 
cially of the semicircular canals. 

Mr. Cooper, the celebrated English surgeon, has shown, 
by experiment and observation, that by the perforation of the 
membrana tympani, we may, in certain cases of deafness, re- 
store hearing. 

Before the writings of Cotunnus and Meckel, we had no 
correct theory of the perception of sounds. Our notions in 
relation to the diseases of the organ of hearing and their treat- 
ment were still more erroneous. 

Notwithstanding these new discoveries, the pathology and 
treatment of the diseases of the internal ear are yet very far 
from having attained to that degree of improvement of which 
they are susceptible. Certain powerful causes have opposed 
obstacles to that improvement. 
3 



18 

1st. The structure of the auditory apparatus is extremely 
complicated; the parts which constitute its structure are so 
deeply hidden, that its diseases are concealed from view; and 
hence the uncertainty of their diagnosis. 

2d. The belief that congenital deafness always depends upon 
some fault of original conformation. In consequence of such 
belief, that species of deafness is regarded as irremediable, so 
that no one presumes to employ the least remedial means. 
Nevertheless, there are means which we can conveniently use, 
and frequently with much benefit. I had an instance of this in 
the person of young Briguet. Congenital deafness, and that 
which occurs soon after birth, often depends merely upon in- 
spissated mucus which obstructs the eustachian tube and the 
cavity of the drum. Nevertheless, I do not pretend to call 
in question the defect of early conformation, which often pre- 
sents itself in the structure of the internal ear, such as we dis- 
cover in other parts of the body; but it is only in this case 
that deafness is incurable. 

3d. The difficulty of applying remedies immediately to the 
part affected, is another reason which has opposed the progress 
of the treatment of the diseases of the ear. That difficulty 
is removed, as regards the affections of the eustachian tube, the 
cavity of the tympanum, and the mastoid cells. The instru- 
ments which I have invented fulfil, in that respect, the end 
desired; for, by means of them, we can convey into those ca- 
vities the liquors which we judge proper. By their means 
many causes of deafness will be removed and hearing restored. 
Of this I am convinced by experiment and observation. 

I do not propose to give a complete treatise on deafness, 
but only to throw some degree of light upon the etiology and 
treatment of that disease, and to furnish some further means of 
overcoming it. Indeed, by considering the diseases which 
affect the different parts of the internal ear, as being the cau- 



M 



19 

ses which may give rise to deafness; by displaying each of 
those diseases; by seeking to ascertain their seats — the causes 
which produce and the symptoms which characterize them, 
the judgment and prognosis, in relation to the nature of deaf- 
ness, will be less conjectural, the treatment more rational, and 
consequently more certain. 

Before entering on the details which each disease may pre- 
sent, we will glance at deafness generally, and first will give a 
clear and concise definition of the disease. We shall avoid 
equivocal terms, or those which are employed with ambiguity. 
We shall reduce the divisions to as small a number as possible. 

Definition. — Deafness is a total loss, or a considerable dimi- 
nution of the sense of hearing. 

Varieties. — We may reduce the varieties of deafness to the 
four following. 

1st. If an infant has the defect at birth, it is called congenital 

2d. If it occur some time after birth, as the result of disease, 
it is denominated accidental. 

3d. If it be the advance of age which gives rise to it, we 
give it the appellation of senile. 

4th. Finally, when deafness attacks only one ear, it is termed 
incomplete, and complete when both ears are affected. 

These four varieties of deafness will be embraced under two 
denominations. 

When deafness is incipient and hearing is merely difficult, 
we shall term the disease (Dysecee) difficult hearing. 

When deafness is complete and absolute, we shall, with most 
nosologists, denominate it (Cophose) complete deafness. 

I shall not introduce, in this division, another defect of hear- 
ing, to which some have given the name of Paracousie, or 
false-hearing. Of those who are affected with it, some hear 
indistinctly words spoken with a loud voice, whilst the per- 
ception of feeble sounds is distinct. Others hear ordinary 



k 



20 

sounds when aided by a loud noise which accompanies them; 
others hear all sounds double. I shall say nothing more of 
this variety of disease. 

Causes.-— The causes of deafness are so numerous, most of 
them so obscure, and some so singular, that it is difficult to 
give a complete enumeration, or a precise classification of 
them; nevertheless, we shall arrange them in the following 
order. 

1st. Defects of original conformation in some part of the 
auditory apparatus,* or the absence of the acoustic nerve, may 
be a cause (a rare one indeed, but ascertained by port-mortem 
examination,) of congenital deafness. 

2nd. Deafness is sometimes hereditary, like many other dis- 
eases, of which, at birth, we receive the germ, or if the ex- 
pression be preferred, the predisposition. Trukaf was con- 
sulted by a man thirty years of age, who had become deaf at 
the age of fourteen years, and whose father, mother, and three 
brothers, or sisters, all suffered the same disease. I know a 
man who became deaf at the age of forty years; he has told 
me that his paternal uncle, his father, and two of his bro- 
thers have, at the same age, experienced the same infirmity. 

A physician who had resided a long time at Marseilles, com- 
municated to me a very singular phenomenon. He informed 
me of a family in that city, consisting of six children, the first 

* Imperfections of the external passages are very rare; I have had occa- 
sion to witness one instance, with Dr. Repiguet, Chirurgien-major des Jlnti- 
quailles. The two passages were closed by continuity of the skin, the por- 
ches of the ears were very imperfect; nevertheless deafness was not com- 
plete. The application of caustic potash on the place where the auditory 
passage should have been, has already so far improved his hearing, that the 
young patient hears almost as well, as if he had never had the defect, so 
little is it necessary to approach him. 

■f Historia Cophoseos. Vindobonae, 1778. 



J 



21 

of whom is deaf from birth; the second hears very well; the 
third is deaf, and so on alternately. Deafness cannot be re- 
garded as hereditary with these children, since the father and 
mother enjoy their hearing in a very perfect state* 

3d. In the interior of the cranium, any thing which may 
compress the auditory nerve, at its origin or along its course, 
and thus obstruct the influence of the nerve upon the auditory 
apparatus, may be regarded as a cause of deafness. 

4th. Deafness, like gutta serena, is sometimes produced by 
inordinate seminal discharges. Sylvatius cites a remarkable 
instance of deafness supervening upon excessive indulgence in 
venereal pleasures. 

5th. Lauzani speaks of a woman who became deaf when- 
ever she was pregnant, and did not recover her hearing till 
after her confinement. She became pregnant four times, and 

* To the above account we may add that of a family at Aix, in Savoy, 
consisting of seven children. The oldest is deaf and dumb, the second 
hears perfectly, the third is deaf and dumb, the fourth is as fortunate as the 
second; the fifth, sixth, and last are perfectly deaf. The eldest of the fa- 
mily, a male, is paralytic in his inferior extremities. He is now at Lyons, 
as is also one of his sisters, at the Institution of the Deaf and Dumb, con- 
ducted by M. Comberry. The last, but one, of these children, is an idiot. 
It should be remarked, that the father and mother enjoy very good health, 
and have none of the infirmities of that numerous and unhappy family. 
There are also in the Institution of which we speak, many pupils who have, 
among their brothers and sisters, one or more deaf and dumb, and whose 
parents are exempt from that affection. 

The town of Bessenay, in the department of the Rhone, furnishes an in- 
stance of the same kind. In a family composed of eight children, four are 
deaf and dumb, and, as in the preceding instances, they alternate with those 
that enjoy the sense of hearing. 

These observations might be still further extended, but I think it will be 
difficult to give a satisfactory explanation, or to form a theory from such 
data. Nevertheless these facts ought to be preserved in the march of sci- 
ence, were they useful merely to indicate its proper limits. Th. P. 



Ik 



22 

as often experienced this inconvenience. The same author re- 
lates the case of the wife of a peasant, who, during gestation, 
besides deafness, was subject to sciatic pains and to ulcers of 
the legs. All these evils disappeared immediately after her 
delivery. 

6th. Worms in the stomach and intestines also produce 
deafness. 

7th. Hypocondriacs, whose digestion is impaired, and who 
often suffer gastric derangements, are subject to become deaf. 
Must we believe, with Etmeller, that deafness, in such cases, 
consists in a spasmodic tension of the tympanum, or other 
membranes of the ear? This much is certain, that many cases 
of deafness have been cured by merely the repeated employ- 
ment of purgative medicines. 

8th. Deafness is a frequent symptom of adynamic and ataxic 
fevers. It is generally regarded as a favourable symptom 
when it happens on a critical day. 

9th. Deafness has been known to follow a violent paroxysm 
of sneezing. Vagner relates, in the Memoirs of Natural Cu- 
riosities, that a literary man, having made use of some sternuta- 
tory powder, became incurably deaf in the right ear. 

1 Oth. A violent and long-continued cough may produce the 
same effect. In the course of this work I cite an instance of 
this cause of deafness, from my own observation. 

11th. Washing the head with cold water is a frequent cause 
of deafness. Cutting the hair, at a particular period of life, 
has produced the same infirmity. 

12th. Chronic issues, suddenly suppressed by topical astrin- 
gents, have also given rise to deafness. 

13th. A violent and unexpected sound sometimes surprises 
the organ of hearing, so as to strike it deaf. To this cause we 
must refer the deafness of soldiers of artillery. They may ex- 
perience a real disorganization of the ear. Richter, in his 




23 

Bibliotbeque Chirurgicale, says, that they are not only liable, 
to become deaf, but even to hemorrhage from the ears. 

14th. Deafness is sometimes produced by blows and falls on 
the head. Authors are replete with observations relative to 
children becoming deaf from cuffs received at school. 

15th. Every thing which may impede the free entrance of 
air into the eustachian tube, such as excessive swellings of 
the tonsils, of the parotid glands; polypus in the posterior 
nares, closure of the expanded orifice of the tube by ulcera- 
tion of the fauces, or merely by inspissated and tenacious mu- 
cus, which adheres to the posterior nares, are so many causes 
of deafness. 

This disease may depend upon morbid changes in the ex- 
ternal parts of the auditory apparatus. The causes of this 
variety are numerous, but it is not my design to speak of 
them here. 

The diagnosis of deafness is difficult, in the same degree 
that the cause is hidden and obscure; thus, injury of the cavi- 
ty of the tympanum and the parts contained therein; the 
affections of the labyrinth, and those of the acoustic nerve, 
are still concealed from us by a veil of obscurity. 

The prognosis is attended with the same difficulties. We 
cannot pronounce it, in a case under consideration, but in a 
conjectural manner. It is true, however, that I have observed 
in many persons affected with difficulty of hearing, and even 
with deafness, (of which the cause was unknown to me,) that 
after the buzzing noise has ceased, the organ of hearing recov- 
ered completely, or in a great degree, the faculty of hearing. 
Generally, hearing is restored in proportion as the buzzing 
noise diminishes; but sometimes the latter ceases whilst the 
deafness persists in the same degree, although, after some time, 
hearing may be restored and become established, even in per- 
sons advanced in life. 




24 

If the causes and symptoms of deafness are so little under- 
stood, we ought chiefly to ascribe the fact to want of know- 
ledge of this morbid anatomy, which is only to be acquired by 
dissection. It is to be desired that physicians to institutions 
of deaf-mutes should practice the dissection of the ear in all 
the deaf-and-dumb who die in those establishments; and that 
they should semi-annually give the greatest possible publicity 
to their researches. Till then there can be nothing but uncer- 
tainty in our acquaintance with the causes, and nothing but 
obscurity in the symptoms of the diseases of the internal ear, 
consequently, improvement in their treatment will be slow 
and laborious. 

The ancient physicians treated deafness with topical reme- 
dies and with powerful purgatives. Celsus and his cotempo- 
raries employed the juice of the wild cucumber, the tincture 
of myrrh, frankincense dissolved in woman's milk, poppy juice, 
rose-water, tincture of castor, &c. &c., which they dropped 
into the external auditory passage. They made use of purga- 
tives, highly drastic, such as elaterium, hellebore, &c. 

Modern medicine employs modes of treatment much more 
varied, but it is not much more successful. It prescribes musk, 
camphor, introduced into the external auditory passage. Some 
introduce, through the same passage, the oils of sweet and 
bitter almonds, those of the kernels of the peach, and of rue; 
oil in which ants have been infused; water which distils from 
the green branches of the ash; injections of the mineral water 
of Balaruc — of Bagneres — of Barege, &c. &c. Some establish 
issues, as those of the seton, caustic, blisters, &c. 

A Bavarian bath-keeper, mentioned by Sckinkius, devised 
a singular method of curing deafness. He plunged the pa- 
tient into a warm bath, to produce turgescence of the little 
veins which run behind the ear. When these were sufficiently 
apparent he opened them with the point of a lancet and drew 






25 

a considerable quantity of blood, to the great relief of the 
patients on whom he practised the evacuation. This remedy 
may have some success in cases of sanguineous plethora of 
the organ of hearing. 

Purgatives are remedies eminently useful in some cases of 
deafness; so much so that, according to Truka, they ought to 
be employed in all cases, except those of debility. 

Penot and Lazare prescribed fomentions, to be applied to 
the head, with warm mineral sulphur-water, the latter also 
recommended aromatic fomentations to the same part. 

Pierre Castro, first physician to the Duke of Mantua, em- 
ployed a mode of treatment which he devised for cases of 
complete deafness. I shall speak particularly of it when I 
shall come to treat of lesions of the acoustic nerves. 

Within about thirty years anatomy has made considerable 
progress. By giving a more particular and exact description 
of the parts which enter into the structure of the internal ear, 
it has thrown light upon the mechanism and functions of each 
of these parts, and has suggested, for the cure of deafness, 
the following modes. 

Riolan has proposed the perforation of the mastoid process 
for the purpose of introducing medicines into the interior of 
the ear. M. Jasser was the first who practised it. 

In 1724, M. Guyot, maitrc des postes, at Versailles, con- 
trived an instrument with which he thought he could inject 
liquids into the eustachian tube, by introducing the instrument 
through the mouth, 

In 1732, Messrs. Wathen and Cleland, English surgeons, 
presented to the Royal Society of London, a flexible and hol- 
low sound by means of which they introduced medicines 
into the interior of the ear, conveying the instrument through 
the nasal fossae, nnd thence into the expansion of the eusta- 
chian lube 
1 




26 

The celebrated Sabatier also invented an instrument for the 
same purpose, but he confessed that he had never tried it on 
the living subject. 

In 1811, 1 devised certain instruments proper for sounding 
the eustachian tube, by the way of the nares. By means of 
those instruments I convey into the ear certain liquids, the 
nature of which varies according to the exigency of the case. 

Natural philosophy, as well as anatomy, also furnishes us 
with certain means for the treatment of deafness — such as 
electricity, galvanism, mineral and animal magnetism. The 
two first have been too much magnified, by encomiums on 
their utility. As to the last, they have had but an ephemeral 
reputation. 

We shall still comprehend, in the class of remedies which 
natural philosophy has furnished, the perforation of the mem- 
brana tympani; because that operation tends to re-establish 
the equilibrium of the air contained in the cavity of the tym- 
panum, with the column of atmospheric air which enters into 
the meatus auditorius — an equilibrium interrupted by ob- 
struction of the eustachian tube. Mr. Cooper was the first 
who performed that operation. 

All the modes of procedure which I propose to offer, will 
be described and discussed in the course of this work. 




ESSAY 



DISEASES OF THE INTERNAL EAR. 



For the sake of arrangement, in treating the subject with 
which we are to be occupied, I have thought it expedient to 
classify the diseases which affect the internal ear, and which 
may become causes of deafness. I name them in the follow- 
ing order. 

First. Diseases of the membrana tympani. 

Second. Diseases of the cavity of the tympanum — of the 
muscles and small bones which are found there. 

Third. Affections of the interior of the eustachian tube. 

Fourth. Diseases which affect organs adjacent to the tube. 

Fifth. Diseases of the labarynth. 

Sixth, and last. Diseases of the auditory nerve. 

Each of the above classes will be the subject of a distinct 
section. 



SECTION I. 

DISEASES OF THE MEMBRANA TYMPANI. 

This septum may be, on the side of the auditory pas- 
sage, overspread by a fungous pellicle — may become thickened 
by some degree of inflammation, or by a polypus attaching 
itself to the external surface. It may be relaxed and protrud- 
ed either into the meatus auditoiius externus, or into the 




28 

cavity of the tympanum. Sometimes it is too tense; inflamed, 
ulcerated, ossified, cartilaginous, or perhaps it is altogether or 
partially wanting. 

"It is but a short time," says Rosenthal, "since I had occa- 
sion to examine, at Breslau, the body of a deaf-mute whose 
deafness had occurred in consequence of small-pox. I found 
the membrane of the tympanum relaxed and thicker than 
usual — the auditory nerve also appeared to be harder than 
common. In other respects all the parts of the internal ear 
were perfectly well organized." 



CHAPTER I. 
On the fungous membrane which covers the memhrana tympani. 

"The membrana tympani, in new-born infants," says Les- 
chevin "is overspread, on the side of the meatus auditorius 
externus, by a very thick fungous membrane, which soon dis- 
appears in consequence of suppuration. Whenever it hap- 
pens that this membrane remains adherent to that of the drum, 
instead of being separated from it, as commonly happens, it 
will necessarily occasion deafness."* 

May not this have been the case with the deaf-mute of 
Chartres, whose history is reported in the Royal Academy of 
Sciences of Paris, 1703, and who began to hear at the age of 
twenty-four years after the occurrence of suppuration in both 
ears? The deaf-mute of whom Riolan speaks, who reco- 
vered his hearing after perforation of the membrane with a 
tooth-pick, was undoubtedly in the same condition. 

M. Le Bouvyers Desmortiers cites an instance very similar 
to the two preceding. "At Nantes, (year 7,)" says that 

* Prix de V Academie royale de chirurgie, torn, iv, in 4to. pp. 




29 

author, "there was a man deaf and dumb from birth, aged 
twenty-eight years, who then heard and spoke very well, 
without having been treated with any remedies. Here is then 
a second phenomenon, equal to that of the young man of 
Chartres. We should be glad to know whether there are 
not many others that have escaped our notice, for want of 
witnesses capable of making them known to us?"* 

M. Le Docteur Portal raises doubts in regard to the exist- 
ence of this membrane. "It is not possible," says he, "to 
ascertain the fact in infancy. The suppuration is said to be 
very imperceptible. I can also state another reason. When 
suppuration occurs the pus blends itself with the cerumen of 
the ear, and hence it is difficult to distinguish it. It is neces- 
sary, in order to remove all doubt in relation to the subject, 
that the child should never be from under the observation of 
the physician or surgeon, and that they should examine the 
whole auditory passage, and the nature of the wax, which, 
during suppuration, is changed in its natural colour, and has a 
strong odour, as well as the auditory passage; but'" adds the 
author, "all these observations are difficult to make," (he 
might say impossible,) "because of the number of circum- 
stances that are often opposed. It is necessary to wait for 
a more advanced period, that is, when the child can make 
known to us that it hears or not."f 

It is certain that this fungous membrane may, in some sub- 
jects, exist at the time of birth, as the membrana pupilaris is 
found to exist in some others. 

Granting that this be a cause of deafness, it cannot be dif- 
ficult to recognise it. By exposing the ear to a strong light, 
and directing the rays of the sun into the meatus auditorius, 

* Considerations on congenital deaf-mutes. 
t Precis de Chirurg. part. p. 477 et 478. 



30 

the bottom of the meatus will be very easily seen, where the 
false membrane adheres to that of the tympanum. If the 
bottom of the meatus be of a pearly white, smooth, and very 
sensible to the touch of the probe, we may be certain that 
the membrane is covered by no obstruction. But if it ap- 
pears red, fungous, but little, or not at all, sensible to the 
probe, we may be assured that the false membrane exists. 

Leschevin proposes two modes of destroying it. One con- 
sists in causing it to suppurate, by irritating the part with 
acrid medicaments; the other, in causing the false membrane 
to wither and to separate by desquammation, by touching it 
with mild corrosives, of dry consistence, as the kali purum, 
applied cautiously. Leschevin gives the preference to the 
latter method, as it appears to him to be attended with least 
inconvenience. 

Both appear to me to be equally dangerous, inasmuch as 
these, irritating substances may give rise to a considerable de- 
gree of inflammation, which the surgeon is not always able 
to arrest, nor even to restrain; hence may arise a deep sup- 
puration, which may destroy the membrana tympani, reach 
the drum, and produce the most serious results. At other 
times, these means, if they affect the false membrane but 
slightly, will prove ineffectual; for, instead of causing the se- 
paration of that kind of foreign substance, either by suppu- 
ration or desquammation, they confer upon it a greater de- 
gree of thickness and consistence. At least this happens 
(if we may reason from analogy,) to those false membranes 
which form upon the globe of the eye, when we treat them 
with similar means. 

Two facts, derived from Frabricius of Hildanus, prove 
how dangerous it is to introduce irritating substances into the 
auditory passages. 






I 



31 

A child, eight years of age, had a discharge from the ears — 
she was placed in the hands of an empyric, who injected into 
them an oily fluid, which produced intolerable pains. These 
pains rapidly increased — inflammation, fever, and delirium 
soon supervened. A physician allayed these symptoms by 
the employment of suitable means, but deafness made rapid 
progress, and at the age of twenty-four years the young per- 
son was insensible to the loudest sound * 

Another child six years of age, introduced into her left ear 
a glass bead, of the size of a pea. Many fruitless attempts 
were made to extract it. From that time the patient was tor- 
mented with continual pains in the ear — these abated, but 
were occasionally increased by cold and moisture. 

At length the child experienced a slight degree of numb- 
ness, which gradually increased, first in the left arm, then in 
the hand, next in the leg, and finally in the whole side. A 
dry cough persisted after this occurrence. The patient suf- 
fered attacks of epilepsy, and the arm became atrophied. All 
these symptoms immediately ceased on the extraction of the 
bead.f 

The accidents mentioned in the above cases, although they 
were not the result of caustic, applied for the removal of the 
fungous membrane adherent to the membrana tympani, are 
nevertheless conclusive, in regard to my opinion; for it is dif- 
ficult, not to say impossible, to introduce any caustic, so as to 
excite irritation in the false membrane, without communicating 
irritation to the meatus auditorius — to the membrana tympani, 
and thence to the interior of the ear. 

From these considerations, I shall give preference to per- 
foration of the tympanum over the method proposed by Les- 
chevin, because it appears to me less dangerous, and because 

* Fabricc de Hilden, cent. 5, observation 5. j Ouvrage cite, 




32 

it restores the patients hearing more promptly than other me= 
thods, as is proved by experience and observation. To pre- 
vent the closing of the aperture, a small portion of gum elastic 
sound should be introduced, which operation must for a time 
be repeated every day. 



CHAPTER II. 

On polypus growing upon the external surface of the membrana 
tympani. 

The auditory passage, like all cavities which are lined by 
a mucous membrane, is subject to polypus excrescences. 
Hence the membrana tympani is subject to the same, because 
its external surface is overspread by the mucous membrane of 
the same passage. Authors make frequent mention of polypi 
which grow upon the walls of the external auditory passage, 
but no one, so far as I know, speaks of polypus arising from 
the membrana tympani, and which increases to such a degree 
as to obstruct the passage and produce deafness. 

The causes which may produce these excrescences are very 
numerous. Every thing, which irritates and produces inflam- 
mation and ulceration of the mucous membrane, may give rise 
to polypus. Thus it is that an ear-pick, introduced frequent- 
ly and rudely into the auditory passage; scabies, scrofula, 
measles, scarlatina, small-pox and syphilis, give rise to inflam- 
mation, ulceration, and by consequence, polypus. 

M. Alibert, in his Therapeutique Medicale, speaks of a 
young man who had become deaf from excrescences which 
had been produced by syphilis. The author does not say 
whether these excrescences were of a polypus kind, 

Adynamic and ataxic fevers often terminate in deafness, 
which is sometimes accompanied by long and obstinate sup- 




33 

puration; hence arises polypus. The following case confirms 
what I assert. 

M. M** # , twenty-two years of age, came to consult me, 
May 1st, 1817; he was affected w r ith deafness of the left ear, 
of which the immediate cause was a polypus, also with diffi- 
culty of hearing in the right ear. These disorders were ac- 
companied with suppuration and a buzzing sound in one or 
the other ear. They supervened on an adynamic fever, 
which the young man had suffered at the age of twelve years. 
Injections of eau de Balaruc, thrown into the auditory passage 
caused the polypus to drop off. 

The substance had the form, colour, and consistence of a 
strawberry, and it was attached to the membrana tympani by 
a very slender pedicle. On examining that membrane I dis- 
covered near the middle a reddish point of the size of a small 
lentil, where I was persuaded that the pedicle of the polypus 
had been attached. 

The separation of the excrescence was followed by a slight 
hemorrhage which spontaneously ceased, without the neces- 
sity of my employing any means to suppress it. The suppu- 
ration and the buzzing sounds have ceased, and the hearing 
of that ear is completely re-established. All this was simul- 
taneous with the removal of the polypus from the meatus au- 
ditorius. 

The symptoms of this form of disease are easily ascertained; 
a single examination is sufficient to determine the existence of 
the polypus in the auditory passage. But it is not thus easy 
to ascertain the precise point where it is attached. 

Nevertheless, whatever may be the point at which the poly- 
pus is attached, that circumstance need not influence the treat- 
ment, which consists in the employment of the following 
means: — twisting it off; removing it with the ligature, cutting 



k 



I 

34 

instrument, actual cautery, or caustic. All these means are 
useful; each being preferable under particular circumstances. 

We find in Scultet* the history of a polypus of the ear which 
had caused deafness by completely filling the auditory passage, 
and which was, in part, cured by tearing it away, and in part 
by the application of the actual cautery. 

M. Leschevinf has seen a young girl suffering from a simi- 
lar excrescence, implanted very deeply in the auditory passage, 
and which issued from it more than half an inch. This excre- 
scence, which Leschevin regards as a true polypus, was fun- 
gous, and gave out a fetid purulent discharge from its sur- 
face. The author removed it by laceration and saw no more 
of the patient. 



CHAPTER III. 

On relaxation of the membrana tympani. 

This affection varies in correspondence with the causes 
which produce it; these causes are very numerous, — such as 
humidity, together with a south wind; catarrh of the meatus 
externus and of the cavity of the drum; damp air; water dash- 
ed upon the membrane; a serous efflux from the ear. Plater, 
Langet and Scarpa, witnessed these abundant discharges, and 
regarded them as important. 

With young women, chlorosis, to a certain degree, is another 
cause of relaxation of the membrane of the tympanum. 

SauvagesJ relates the case of a girl of pale complexion, 
very dull and uncultivated, who had had, for some time, a dif- 

* T. 2. p. 605, edit. d'Amsterdam, 1741. 

t Prix de l'Acad. de Chirurg. toru iv. 1. re partie. 

} Nosologic, torn, ii, page 217. 



A\ 



" 



25 

ficulty of hearing. She took, for three months, the extract of 
henbane, beginning with a third of a grain and increasing the 
dose, by little and little, to seven grains. This child, says 
Sauvages, heard very well at the end of three months and a 
half; she recovered her flesh and complexion. 

Verduc thinks, on the contrary, that the use of cold and 
narcotic remedies, in diseases of the ear is a cause of the re- 
laxation of the membrana tympani. This author, however, 
cites no fact to substantiate his opinion; and, besides, his rea- 
soning is contradictory, a circumstance which does not inspire 
confidence. "If we make," says Verduc, "very great use of 
refrigerant and narcotic medicines, in diseases of the ear, the 
covering of the drum will certainly become very dry and very 
tense." 

Finally, relaxation of the tympanum may also depend upon 
disease of the muscles of the cavity. Valsalva, in his observa- 
tions, cites examples of it. Defect of action in the internal 
muscle of the malleus produces relaxation of the membrana 
tympani. This defect of action, according to Leschevin, may 
arise either from rupture of the tendon of the muscle, by a 
violent concussion of the membrane, such as is produced by 
sneezing, the nose and mouth being shut; or by the destruc- 
tion of this little fleshy body, by an abscess of the tympanum; 
or, finally, by paralysis of the same muscle. May it not have 
been this last affection which occasioned relaxation of the tym- 
panum and by consequence that singular deafness of which 
Willis reports two instances. 

The first is of a woman who could hear only when some 
one beat a drum at her ear. 

The second, essentially like the other, is of a man who ne- 
ver heard the voices of those who spoke to him, but when the 
bells of a steeple were rung, near which he lived. Willis, with 
much judgement, ascribes this species of deafness to relaxa- 



L 



36 

lion of the mcmbrana tympani; but he neither points out the 
cause nor the remedy. 

The symptoms of this affection are derived — 1st. from the 
causes which may have given rise to them; 2d, from hygro- 
metric phenomina of the atmosphere; 3d, from the nature of 
the prevailing wind; 4th, from the action of remedies upon the 
injured part. 

If, after catarrh of the external auditory passage, and that 
of the cavity of the tympanum; or, after dropsy of this last 
cavity, the patient experiences difficult hearing, we shall have 
cause to believe that the indisposition depends upon relaxation 
of the membrane of the tympanum, or upon palsy of the in- 
ternal muscle of the malleus, (tensor tympani). This presump- 
tion will receive new assurance if the deafness is observed to 
be augmented during a damp season, and diminished when the 
weather is dry. We shall be still more confident of the ex- 
istence of relaxation, if the south wind, and a tempestuous sea- 
son, render the patient still more deaf, while the north wind 
produces the opposite effect. 

Finally, there will be complete certainty, if, independantly of 
the symptoms which we point out, it happens that dry sub- 
stances, warm and tonic, introduced into the external auditory 
meatus, give some degree of power to the faculty of hearing; 
for it will be evident from this that the deafness depends on 
relaxation of the septum of the tympanum, and not on a lesion 
of the acoustic nerve, (as some symptoms manifested might 
lead one to suppose) because the means are sufficient to re- 
store the tone of the membrane, whereas their influence is 
nothing upon the auditory nerves. 

In order to determine the diagnosis of this disease, there is 
one thing more to be explained, that is, the oase in which the 
relaxation may be occasioned by paralysis, or rupture of the 
internal muscle of the malleus or that of its tendon. If, after a 



A\ 



37 

fit of coughing or violent sneezing, or strong effort in blowing 
the nose, the individual experiences, in the interior of the ear, 
a slight, instantaneous pain, accompanied with a tingling sensa- 
tion, and with difficulty of hearing, and there is no sign which 
indicates a perforation of the membrana tympani, then we must 
attribute the relaxation to one or the other of these ruptures, 
especially if the means proper for restoring the tone of the 
membrane, of the tensor-tympani, and of the acoustic nerve 

ve been ineffectual. This will show that the relaxation de- 
pends on one of the causes of which we speak; the disease is 
then incurable. 

To treat successfully, relaxation of the membrana tympani, 
it is necessary, as in all other diseases, to pay attention to the 
cause which may have produced it. I will not enumerate, in 
this place, all the means which the ancients, or even the mo- 
derns have employed, among which it must happen that there 
are many very good, but also many very useless or even ridi- 
culous. I shall speak only of the former. 

If the relaxation depends upon a catarrhal affection, Duver- 
ney advises fumigations of the external auditory passage with 
the vapour of the carduus benedictus, (chardon-benit) or with 
a decoction of the iris of Florence, marjoram, balm, anise-seed 
or fennel; the juice of marjoram dropped into the auditory 
passage. 

Barbette employs a decoction of cloves in red wine, of 
which he introduces a few drops into the auditory passage, 
which he then fills with a clove. 

All these means may be attended with happy effects, in ca- 
ses which we have designated and in which the relaxation de- 
pends upon humidity of the atmosphere. 

In similar cases, fumigations of juniper berries, and of lau- 
rel consumed upon burning coals, will be beneficial. Injec- 
tions of the decoction of cinchona have, with me, been benefit- 



i 



38 

cial; but I would not have too much confidence placed in this 
remedy, because of its astringent property, which tends, if we 
may so say, to tan the membrane. 

If the disease of which we speak be caused by chlorosis, 
we must first relieve that affection; then, if the relaxation of 
the membrane persists, recourse must be had to the remedies 
which we have pointed out. 

We have said that the relaxation which arises from rupture 
of the tensor-tympani, or its tendon, is incurable; but this is 
not the case with regard to that variety which proceeds from 
paralysis of the muscle. In the latter case Leschevin recom- 
mends to introduce into the cavity of the tympanum, through 
the eustachian tube, some spirituous and aromatic vapour, by 
causing it to be breathed through the nose, and directing the 
patient to chew substances impregnated with stimulating and 
aramatic particles. 

It is obvious, though I were not to mention it, that these 
means are by no means sufficient to convey effectually these 
medicaments into the diseased part. We shall derive very 
great advantage from lotions of the mineral water of Balaruc, 
of Barege, &c, introduced into the cavity of the tympanum 
by means of the hollow sound which I have invented. 



CHAPTER IV. 



On the sinking or protrusion of the membrana tympany in the 
form of a pouch, (cul-de-lampe), either into the meatus au- 
ditorius or into the cavity of the tympanum. 

The causes of deafness are innumerable, and every day we 
discover those which are new. For example, authors make 
mention of relaxation of the tympanum with protrusion into 
the meatus auditorius; but no one, so far as I know, has spo- 






39 



ken of the sinking of this membrane into the hollow of the 
tympanum. I will relate an instance of it in the person of a 
priest of this city. 

M. l'Abbe L****, aged sixty-two years, had been deaf with 
the right ear since the age of six, but with the left ear he had 
enjoyed very exquisite hearing. It was not till the beginning 
of the year 1816 that this organ became affected with very 
great difficulty of hearing, (dysecee), which obliged him to 
abandon some of the duties of his calling. 

The deafness had evidently been altogether produced by a 
violent and protracted cough. 

M. PAbbe L** ## had been affected for three months, with 
this degree of deafness, when, April 27th, 1816, he came to 
place himself under my care. He heard only when a person 
spoke to him in a loud voice and very near, and when conver- 
sation became general, he could take no part in it. He could 
not hear the beating of a watch but when it was very closely 
applied to the porch of the ear. He experienced a sensation 
like that which a foreign body would produce, lodged in the 
cavity of the tympanum, and also felt, in the part, a disagree- 
able pulsation. On attentively examining the auditory passage, 
I perceived that the membrana tympani was depressed, and 
formed a pouch in the cavity of the. tympanum. From that 
time I had no doubt that this was the immediate cause of the 
deafness of the ecclesiastic. The cure of this disease consists 
in re-establishing the natural form of the membrane. This 
may be accomplished by means of injections, conveyed into 
the cavity of the tympanum, through the eustachian tube. 
The first trial of it has been sufficient to restore hearing. 

A circumstance which may contribute to the progress of the 
science, and which, for that reason, I am unwilling to pass over 
in silence, is, that we must discontinue all injections, and espe- 
cially abstain from introducing them into the external meatus, 




40 

as soon as the membrane has recovered its natural form, and 
hearing is restored; otherwise the disease will be reproduced 
as it was before the treatment. This happened to me, in re- 
gard to M. PAbbe; at the second or third sitting, I made a few 
injections into the meatus externus. The next day my patient 
told me, with an air of discouragement, that he was as deaf as 
before the treatment. I then perceived the unfortunate error 
which I had committed; but at the same instant I conceived 
the hope of immediately repairing the mischief. Indeed a few 
injections through the eustachian tube have sufficed to restore 
the membrane, and consequently hearing, to their natural state. 

At the first glance, the cure of this malady seems to be al- 
together mechanical, but I believe that the water of Balaruc 
by its tonic virtue, ought to be regarded as of some account in 
the treatment. 

When the membrane protrudes into the meatus auditorius it 
is very easy to distinguish the affection; mere inspection is suf- 
ficient. 

The causes which produce it are — 1st, coughing, violent in- 
spiration, and sneezing (lest any one should accuse me of in- 
consistency, these causes may really produce the contrary 
effect, of which I have cited an instance in this chapter); 2d, 
more frequently, this protrusion of the membrane is owing to 
an accumulation, sometimes of mucus, sometimes of pus, some- 
times of rarified air, contained in the cavity of the tympanum. 

In the latter case it will suffice to depress the membrane 
slightly with a blunt probe, and to stuff gently the external 
meatus with cotton or lint, which should remain for forty-eight 
hours. After removing this simple application, the mineral 
water of Balaruc should be injected twice or thrice,* luke- 

* This water possesses tonie qualities; and also, by virtue of the salts 
which it contains, slightly stimulates the organ. We, of course, cannot 




41 

warm; or indeed a weak infusion of cinchona of the same tem- 
perature. Then it is to be dressed as above. Six or eight days 
suffice for a cure. 



CHAPTER V. 

On morbid tension of the membrana tympani, 

Duverney and Leschevin ascribe preternatural tension of 
the membrana tympani to violent diseases of the head, and to 
certain fevers which tend to produce phrensy. 

To these general causes we ought, as I think, to add inflam- 
mation of the fauces, imparted to the eustachian tube, for we 
observe in this case the sense of hearing to be morbidly in- 
creased. Indeed the slightest noise disturbs the patient; the 
north wind renders his situation insupportable, and that of the 
south relieves him. 

The symptoms which characterise this species of disorder, 
and those which indicate relaxation of this membrane are op- 
posite, that is to say, the patient hears better when the season 
is humid and when the south wind prevails, than when the 
weather is dry, and the north wind blows. He hears better 
when he is addressed in a low tone and near the ear, than 
when he is spoken to in a high tone. 

If the tension arises from any one of the causes of which we 
have made mention, we should especially direct our attention 
to the primary disease, without, at the same time, neglecting 
the secondary. 

obtain the article, but it is easy to devise something which shall produce a 
similar effect. I would recommend, for this purpose, a weak solution of 
the sulphate of zinc, or indeed a very weak one of corrosive sublimate, say 
in the proportion of one grain to two ounces of water. Some might prefer 
an astringent vegetable decoction. N. R. S. 

6 



k 



42 

Baths of the vapour of emollient decoctions, directed into 
the external meatus; dropping the same decoctions prepared 
with warm milk into the ear; the fresh oil of sweet almonds, 
conveyed to the bottom of that passage by means of a little 
cotton, produce very good effects. The topical application, 
should be repeated frequently during the day. 



CHAPTER VI. 

On inflammations of the membrana tympani. 

The membrana tympani, like all other parts which possess 
blood-vessels and nerves, is susceptible of inflammation; that 
inflammation may be either acute or chronic. It is rare that it 
is confined to the membrane alone. It ordinarily attacks the 
mucous lining of the meatus externus; that of the cavity of the 
tympanum may participate in the disease. 

Experience and observation prove that the acute inflamma- 
tion of the membrana tympani most frequently terminates by 
resolution, sometimes by suppuration, rarely by catarrhal effu- 
sion; the last however is the ordinary termination of chronic 
inflammation. 

The causes of inflammation of the membrana tympani are 
the same as those which produce inflammation of the external 
auditory passage; such as the presence of a foreign body, the 
too frequent introduction of an ear-pick, or any other irritating 
body. 

I knew a young person who has the bad habit of constant- 
ly introducing a pin, quite to the bottom of the passage, under 
the pretext of cleaning the ear. From this, inflammation of 
the auditory passage and of the membrana tympani has al- 
ready several times arisen. 

The repulsion of the humour of itch, from the skin, may 



A 



43 

also give rise to inflammation. It may also, like many other 
diseases, arise from an internal cause. 

Acute pain, fever, painful sensations caused by the slightest 
noise, especially when the mouth is opened in masticating 
food, are the symptoms and indications which show acute in- 
flammation of the membrana tympani. 

Chronic inflammation is much less painful; generally, indeed, 
it is not all so, but it is accompanied with a mucous or serous 
excretion, and sometimes it itches in a troublesome manner. 
In the latter case there is always difficulty of hearing, because 
of the extraordinary thickness which the membrane acquires 
from continued inflammation. 

Acute inflammation may be effectually overcome, without 
there being left any unpleasant consequences. This is not the 
fact, however, in regard to chronic inflammation, for it is rare 
that those who have been afflicted with it, do not retain a 
greater or less degree of deafness. 

The extraction of the foreign body, preventing the indi- 
vidual from wilfully irritating the membrane; bleeding in the 
arm or foot, if inflammation depends upon general plethora; 
the application of leeches near the angle of the jaw, and under 
the diseased ear, if the plethora be local, are the first indica- 
tions to be pursued. 

If a repelled eruption, or an habitual discharge, unadvisedly 
suppressed, be the cause of inflammation, the indication will 
be to restore the eruption by the application of a blister. 
After having fulfilled the first indication, the following means, 
whatsoever may be the cause of the inflammation, are to be 
employed. 

Emollient vapours, such as those of a decoction of mallows 
with milk, introduced, as a bath, into the auditory meatus; 
those liquids dropped warm into the same part; the applica- 
tion of emollient and anodyne poultices, immediately to the 



ik 



44 

porch of the ear, after having filled the meatus with cotton, 
moistened with the warm fresh oil of sweet almonds; sina- 
pisms to the feet, and emollient enemata, ought not to be 
omitted. The regimen will be more or less severe, according 
to the intensity of the symptoms. Chicken water, whey, or 
some other lenitive and cooling liquid, should be the ordinary 
drink. 

Such is the treatment proper for acute inflammation, which 
sometimes terminates in suppuration. When this is the case, 
it is necessary to make use of detergent injections, such as 
those of barley-water with honey, a decoction of briar leaves, 
the mineral water of Balaruc, or that of Barege, &c. &c. # 

As to the chronic inflammation, it is to be treated in the 
same manner, with, however, some modification of the means 
proposed. Blisters and caustic issues are here indicated, to 
be applied to the neck or arm, and never upon the region of 
the mastoid process. Among the number of bad effects that 
I have seen result from the latter practice, I will merely re- 
port the two following. 

Th. S # * # , was attacked with rheumatic pains in the left 
ear, after having passed many nights on guard, during the 
siege of Lyons. 

The pain ceased, but there remained a considerable degree 
of buzzing noise in the ear, and difficulty of hearing. Some 
one applied a blister over the mastoid region. The result was 

* No one can read the above paragraph, and its context, without being 
struck with the contrast between the scientific precision of French patho- 
logy, and the imbecility and diffusiveness of some part of their practice. 
In case of suppuration occurring in the membrana tympani, the practitioner, 
instead of lamenting that he has not the water of Balaruc or Barege, may 
deterge the ear with a weak alkaline solution, and when the inflammatory 
excitement has abated, may employ in the same manner a weak solution 
of sulphate of zinc, sublimate, or nitrate of silver. N. R. S. 



45 

an increase of the buzzing sound and of the deafness. Not 
satisfied with his condition, M. S* # * consulted M. M***, who 
healed the blister, and applied another to the arm of the side of 
the diseased ear. The patient is perfectly cured of the buz- 
zing sound and of the deafness. 

Madam G ### , grocer of this city, after an accouchment in 
1804, had an inflammation of the external auditory passage in 
both ears, and particularly of the membrana tympani. Not- 
withstanding a great number of remedies, the inflammation 
was protracted and obstinate, and yielded only to a caustic 
issue applied over each mastoid region. To the inflammation, 
there succeeded a degree of deafness, which every day grew 
worse. The patient informed me that she had perceived the 
deafness from the very first day of the application of the 
caustic. From facts derived from my own practice, and 
those with which my professional brethren have furnished me, 
it is certain that blisters, and especially issues, applied over 
the mastoid processes, produce congestions in the mastoid 
cells, in place of relieving them, and hence these drains be- 
come causes of deafness. 



46 

CHAPTER VII. 

On induration of the membrana tympani. 

It sometimes happens that this membrane becomes indura- 
ted,* being either cartilaginous or bony.f 

These affections may arise; first, from inflammation;^ second 
from tumefaction of the glands of that septum, an affection 
which Bartholin declares to be very common in persons af- 
fected with abdominal dropsy; third, from the venereal virus; 
fourth, from the abuse of spirituous liquors, as has been ob- 
served by Hoffman; fifth and lastly, from old age. 

We may ascertain the existence of induration of the m. t. 
by the following signs: 

1st. By deafness more or less complete; 2d, by diminished 
sensibility of that membrane, when it is merely hardened, but 
if it is cartilaginous or ossified, it is altogether insensible to 
the touch of a probe; 3d, by the want of elasticity and re- 
sistance which it opposes to the probe, and, if it is ossified, by 
the sound which it emits when we strike it with the instru- 
ment; 4th, Savauges§ observes, that if induration of the mem- 
brana tympani proceeds from the venereal virus, the expan- 
sion of the ear is covered with scales which are easily de- 
tached, leaving the organ red. 

This symptom appears to me to be equivocal, for, if the 
disease arose from predisposition to tetter, the same phenome- 

* Duverney, Traite de V organe de l'ouie, p. 176. 

f Losecke, Obs. anat. chirurg. med. p. 24, 25. 

\ We know that membranes which have been for a long time inflamed, 
retain, after the resolution of the inflammation, a much greater thickness 
than they had before. The membrana tympani may become thickened in 
the same manner. 

| Nosoligie, torn. 2, in. 8. 



'I 



47 

non would . manifest itself in a more remarkable degree. In 
relation to this subject, I recollect that, when I was surgeon in 
ordinary to the Hotel-Dieu de Lyon, I had occasion to see 
many persons affected with tetter, some of whom were com- 
pletely covered with the disease; the nails of the hands and 
feet were thick, hard, and of a dirty white colour; the ears 
were red and scabby, and hearing was difficult. 

When the disease of which we are speaking is not much 
advanced, which may be known by the degree of sensibility 
which the membrane still possesses, and by the organ not 
having altogether lost its faculty of hearing — if things are in 
this state; and, for example, the cause of the disease is refe- 
rable to venereal virus, we should commence the treatment 
of syphilis, while, at the same time, we should not lose sight 
of the local disease. A blister should be applied to the arm 
on the side of the diseased ear, and be kept open for some 
time, and if the case requires it, a caustic issue should be 
substituted. At the same time we may employ, with advan- 
tage, injections of the infusion of the flowers of violets, or of 
mallows, with which a few drops of the liquor of Van Swie- 
ten have been blended, into the auditory meatus. 

If tumefaction of the glands of the membrane be the cause 
of this induration, whether it be the effect of a strumous or of 
a dropsical habit, in either case, besides encountering the prin- 
cipal disease, we should establish a caustic issue on the arm of 
the affected side. In the latter case, we should inject into the 
auditory meatus warm water, to which a few drops of am- 
monia have been added. These injections will stimulate the 
glands agreeably, and favour their resolution. 

When the membrana tympani has acquired a degree of 
thickness, and especially when it is ossified, all general and 
topical remedies are useless. The first may indeed remove 
the original cause, but the effect will remain , For this reason 



k 



48 

M. Leschevin* says, that if the thickening has become so con- 
siderable as to intercept the vibrations, of the air, art cannot 
repair the defect. M. Portal is very nearly of the same opi- 
nion; he says, "if the thickening of the membrane is consider- 
able, this variety of deafness is as incurable as that of old per- 
sons;" but he adds — "It remains to be learnt whether it would 
not be warrantable to make a small perforation in the mem- 
brane.f 

Thus that celebrated professor anticipated the success which 
should one day attend the operation of perforating the tympa- 
num, in certain cases of deafness. It is proper, exclusively of 
other means, in the case in which he has proposed it; provided 
always, that the induration, or, ossification, arises not from the 
progress of age. 

The idea of piercing the membrana tympani, for the pur- 
pose of restoring hearing to the deaf, was conceived by the 
celebrated Chesselden. I have just stated that Professor Por- 
tal proposed the same operation more than forty years since. J 

* Prix de 1' Acad. roy. de Chirurg. torn. iv. in — 4, 1. re partie. 

f Precis de chirurg. pratique, torn 2, p. 480. 

J It will, perhaps, not be improper to suggest here, that, in order that 
hearing may be perfect, and that the membrane may execute its functions 
freely and perfectly, it is necessary that it be constantly placed between 
two columns of air in equilibrium with the atmosphere, and each commu- 
nicating freely with it. This, in the natural condition of the organ, is 
effected, on the one hand, by the eustachian tube, and on the other by the 
external meatus. If, by any accident, the eustachian tube happens to be 
obliterated, or only obstructed, the air contained in the cavity of the drum 
loses its elastic quality and its vital property; qualities without which 
this fluid cannot be in equilibrium with the atmospheric air, as it was 
before the accident. In that case, it is necessary to restore the equilibrium, 
between the two columns of air, by restoring the functions of the eustachian 
tube, which, till recently, was regarded as very difficult, or even impossi-^ 
ble. Hence, undoubtedly, arose the idea of opening a communication be- 
tween the air contained in the cavity of the drum and the external air 



A 



49 

Mr. Cooper, the English surgeon, appears to have been the 
first who practised the operation proposed by the two distin- 
guished men whom we have quoted above. Since Mr. Coop- 
er, many French and German practitioners have employed 
this method; among the first, we notice M. M. Celliez, Mau- 
noir, and Itard. The last has added, with advantage, injec- 
tions, which he introduces into the interior of the ear, by 
means of the artificial opening made through the membrana 
tympani. 

Mr. Cooper recommends the perforation of the membrane, 
in case the eustachian tube is obstructed or imperforate, in or- 
der to establish a communication of the drum with the atmos- 
pheric air, and thus to restore the vibrations of the membrane 
of the foramen rotundum, and the play of the stapes, the base 
of which covers the foramen ovale. 

Mr. Cooper's operation consists in introducing into the ex- 
ternal auditory passage a small trochar, contained in a canula. 
When the extremity of the canula touches the membrana tym- 
pani, he pushes forward the trochar. The instrument should 
be adjusted in such a manner, as that the instrument cannot 
pass more than a line and a half, or thereabouts, from the ex- 
tremity of the canula. "The place most convenient for the 
perforation," says Mr. Cooper, u is at the anterior and inferior 
1 part of the membrane, below the handle of the malleus, which 
must not be touched." 

"Although the membrane is vascular," adds the author, "its 
vessels are so small that they yield but very little blood. If a 
considerable quantity is observed to issue, we may conclude 
that the operation is not properly done."* 



' which fills the external auditory meatus, by perforating the membrana 
tympani. 

*Biblioth, Germ, torn- viii, pp, 100 et 401, 

I i 



k 



50 

Mr. Cooper relates four cases in which his operation was 
attended with success. Among these cases there is one, the 
subject of which was a young man of 17 years, deaf and 
dumb from birth. Mr. Cooper ascertained that this young 
man had a defect of the throat, which rendered him unable, by 
blowing the nose, to force air into the ears, the eustachian 
tubes having no orifices towards the throat * 

I shall not here examine upon what circumstance the theory 
of the author is founded, but it is important to direct our at- 
tention to the operation itself, and its results. 

1st. Is the operation proposed by Mr. Cooper always prac- 
ticable? 

2d. Are we sure of reaching the spot indicated by the 
author? 

3d. In cases approved by Mr. Cooper, will the operation 
always be followed with success, provided the operation be 
done in the manner prescribed? The above are questions which 
it is important for us to examine. 

1st. There are but few circumstances which can prevent the 
perforation of the membrana tympani. I can discover none, 
indeed, but polypus or fungous, which can present any obstacle 
to the operation. 

2d. The preferable place for operating, pointed out by the 
author, will be attained with difficulty, whatever may be the 
information and dexterity of the operator. The motions of 
the patient, the very small distance that there is between the 
part which is to be perforated and that which is to be avoided, 
present obstacles which must be with difficulty overcome, 
and, consequently, will in some degree defeat the success of 
the operation. 



* It is to be desired that Mr. Cooper had said how he ascertained the 
fact. 



51 

If we consider, indeed, that the membrana tympani is 
scarcely more than two lines and a half in its greatest diame- 
ter — that the malleus occupies more than a third of its sur- 
face, to the centre of which the handle of that little bone is 
attached, we shall perceive that it is almost impossible to ac- 
complish the proposed operation without injuring the appara- 
tus of hearing. 

3d. The mere perforation of the membrane will be useless, 
whenever concrete substances, such as those of coagulable 
lymph, of extravasated and coagulated blood, or any other 
substance, may obstruct the cavity of the tympanum, the mas- 
toid cells and the eustachian tube; because the solid matter 
which obstructs these cavities, not being susceptible of being 
evacuated by the simple perforation of the membrana tympani, 
opposes an insuperable obstacle to the ingress of the atmos- 
pheric air, which should come in contact with the foramina 
rotundum and ovale, a circumstance without which hearing 
cannot be exercised. A single instance is sufficient to prove 
the truth and accuracy of my assertion. 

M. Itard, physician to the institution of deaf-mutes in Paris, 
performed, on the 2d of July, 1811, the puncture of the mem- 
brana tympani upon the person of a congenital deaf-mute, aged 
15 years. It is not asserted that the young man heard from 
the time that the operation was performed. He did not hear 
until the repetition of injections into the ear had been prac- 
tised for three months .* 

It is obvious that, in this case, there was some obstruction 
in the cavity of the tympanum; for, if this cavity had been 
free, the young man would have heard from the time that the 
operation was performed. Now I ask, whether, in this case, sim- 
ple puncture of the membrana tympani would have sufficed to 



* Journal de 1'Empire, 31 Octobre, 1811. 



I 



52 

make this deaf-mute hear? 1 believe that the most decided 
advocate of this method would not presume to answer in the 
affirmative. 

For myself, I think that, if Dr. Itard had not made the in- 
jections of which he speaks, the young man would have re- 
mained in his former condition. 

Injections, by the eustachian tube, would have been perfect- 
ly successful in this case, and there would have been incurred 
none of the serious hazards, to which the puncture of the 
-nembrana tymparii exposed him. 

4th. From a precise knowledge of the relation of the mal- 
leus to the membrana tympani, we may safely predict that, in 
performing three punctures, at least one will touch this little 
bone, and perhaps even detach it; and thus the organ of hear- 
ing will be greatly injured; for, if it is true that the mere 
puncture of that membrane may be followed by deafness, as 
Duverney,* Lecat,t HallerJ le Dictionnaire des Sciences,^ &c. 
&c. assure us; as also experiments upon living animals prove, 
and the instance of artillery-men and bell-ringers, (I believe, 
however, that deafness in those persons arises rather from vio- 
lent and repeated concussions of the whole organ of hearing, 
than from the mere rupture of the membrane,) what must be 
the result when the malleus is detached or damaged in conse- 
quence of the operation? 

There are, I know, some instances of accidental perfora- 
tion of the membrane, which have not produced complete 
deafness — which, indeed, have had but little influence upon 
the faculty of hearing; but I cannot think that these single and 

* Traile de l'organe de l'ouie, p. 61 et 62. 

fTraite des sens, torn. 3, p. 146. 

\ Haller. 

§ D ctionnaire des Sciences, torn. 15, in fol. 



J 



53 

insulated facts should have more weight than the repeated ex- 
periments, and the numerous observations made by the most 
ingenious members of the profession. 

Instances are cited, of smokers, who can force tobacco 
smoke from the mouth through the ears; but it appears to me 
that there is a distinction to be made between the work of na- 
ture, and that which is effected by disease, or by the hand of 
man. 

Independently of the inconveniences with which we charge 
the method of Mr. Cooper, there is another which, without 
being severe to the patient, is very annoying to the operator — 
that is, the closure of the artificial opening which has been 
made. 

M. Sabatier says, on the subject of the perforation of the 
membrana tympani: "Animals in whom the membrane has been 
perforated with an instrument, deeply introduced into the me- 
atus auditorius, experience no other inconvenience than a de- 
gree of temporary imperfection in hearing, and soon recover 
their ordinary state, undoubtedly, because the opening thus 
made, promptly becomes closed as before."* 

The experiments of Valsalva substantiate the conclusion of 
Sabatier. Valsalva perforated, and even lacerated the mem- 
brana tympani, in several dogs, which, after some time, he 
killed. In all, the wounds were cicatrized, and the membrane 
presented no opening. 

M. Maunoir experienced this inconvenience in the person of 
M. F., in whom he perforated the membrana tympani of both 
ears. "Twenty days after the second operation," says M. 
Maunoir, U M. F. came to me. I examined his ears by a good 
light. The membrana tympani of the right ear was seen to 
be marked with a little cicatrix, toward the anterior part, and 

* Sabatier. Traite d'anat. % p. 186. 



\ 



54 

a very small hole was just discernible in the centre. Hearing, 
however, was but little diminished. Fearing that this little 
opening might close altogether, M. F. desired that I would 
perforate the membrane again; an operation which I perform- 
ed without pain to the patient, and also with some slight in- 
crease of sensibility in the ear."* 

M. Celliez believed it possible to obviate that inconvenience 
by the aid of a curved trochar, of a diameter three or four 
times greater than that of Mr. Cooper, and of which the an- 
gles are sharper, u in order," says M. Celliez, "that the ragged 
margins of the wound, being larger and more freely cut, may 
fold back the better upon themselves, and thus render re-union 

impossible."t 

But would not M. Celliez, in avoiding one evil, fall into one 
more serious? I fear so. If, indeed, with the trochar of Mr. 
Cooper, we incur the risk of detaching and even breaking the 
bony process of the malleus, what will be the hazard with 
that of M. Celliez? With such an instrument, I think that the 
accident would rarely be avoided. 

In cases, in which the method of Mr. Cooper is the only 
means which can be employed, I should prefer his trochar to 
that of M. Celliez, giving, however, a slight curvature to the 
former. 

Having learnt that the introduction of a trochar, armed with 
a silver canula, was difficult for the operator and painful to the 
patient, and that the opening made in the membrane was liable 
to close, I have devised the following improvements. For the 
silver canula, I have substituted one of elastic gum, which by 
its flexibility, adapts itself, without difficulty and without pro- 
ducing pain, to the canal through which it passes. The ca- 

* Journal de Medicine, an. xiii. 

t Ouvr. cite, meme annee et meme moil. 



1 



55 

nula is a line and a half longer than the shaft of the trochar, 
which is slightly curved, especially towards the point. The 
shaft of my trochar is a little larger than that of Mr. Cooper's; 
but it is less than the instrument of M. Celliez. 

To prevent the subsequent closure of the opening made in 
the membrana tympani, I insert a piece of cat-gut, which en- 
ters about a line or a line and a half into the drum of the ear. 

In performing the operation, the patient being placed in an 
easy chair, opposite to a good light, the head inclined toward 
the shoulder of the side opposite to that on which the opera- 
tion is to be performed, and supported on the breast of an as- 
sistant, the canula is to be dipped in olive oil, and introduced 
by itself into the meatus extermes. When it touches the mem- 
brana tympani, which is known by the resistance that is felt, 
the trochar is to be gently conveyed into the canula, the cur- 
vature being directed downward and forward, in introducing 
the whole shaft. The puncture being made, the trochar and 
canula are to be withdrawn. Then the cat-gut is to be intro- 
duced, carefully dipped in the oil of sweet almonds. When 
it has reached the desired point, (which may be known by a 
mark made on the instrument with ink,) it is to be fixed with 
lint or charpie. Then the cat-gut is to be cut off even with 
the concha of the ear. 

This dressing is to be renewed every twenty-four hours; 
and, at the first dressings, an injection or two of the infusion 
of the flowers of violets or mallows should be made, and af- 
terwards injections of barley water, sweetened with honey. 

I have twice practised this operation on the same individual , 
and on the same ear. The first time, the opening made by 
the puncture was completely closed in the course of from six 
to twelve days. As soon as I was sure that the first operation 
had not succeeded, I performed the second in the manner that 
I have described above, and the success was complete, 



56 

"Professor Dubois," says M. Richerand, "has performed 
the puncture of the membrana tympani four times without suc- 
cess, on subjects aged from thirty to fifty years. This inu- 
tility of the operation, proved by the four instances so well 
authenticated, will tend to make the correctness of other ob- 
servers doubted — at least to show that one should not always 
promise himself success."* 

I entertain, in that respect, the opinion of Professor Riche- 
rand, and I will also add, that there are a great many circum- 
stances which may defeat the operation. In other cases suc- 
cess will be but temporary ,f There will be but few cases in 
which it will be successful. 

*Nosographie Chirurgicale, torn. 2, p. 132. 

t If the operation is not attended with the success which one might ex- 
pect; and if, most frequently, the patient does not recover hearing but in 
an imperfect manner, and for a short period of time, it proves clearly that 
the exterior air, freely introduced into the cavity of the drum, produces 
the effect of a foreign body, changes the sensibility of the very delicate 
ramifications of the auditory nerve, and hence effects a morbid condition 
of the other organs of hearing. 

M. Deleau, Jun., who is engaged with much success in treating diseases 
of the ear, is the inventor of a very complicated instrument for making 
the puncture with loss of substance to the membrana tympani. It would 
be necessary to enter into too long a detail, to give a correct idea of the 
instrument-, for this, therefore, we shall refer to the memoire which M. 
Deleau published in February, 1822. We will merely say, "that the part 
of the instrument designed for the operation, is composed of a steel canu- 
la, of which the extremity that is to touch the membrana tympani, has an 
opening, a line in diameter, and is cut obliquely, in order to be more per- 
fectly adapted to that membrane, which has a similar direction relatively 
to the concha of the ear. The extremity of the canula is sharp, and re- 
ceives in its whole length a mandrin, of which the extremity, which cor- 
responds to that of the latter, presents two cutting edges, one superior or 
anterior, the other inferior or posterior. These two little edges, oblique 
from before backward, unite and form, together, an irregular pas-de-vis (turn 
of a screw,) a line in length, and terminated by a very sharp point designed 



i 



57 

After having stated the inconveniences of this mode of 
treatment, it is our impartial duty not to conceal its advan- 
tages. 

M. Savary thinks that the perforation of the membrana tym- 
pani, for deafness, is only useful when that membrane is inca- 
pable of performing its functions, or when it impedes the pas- 
sage of sound. "It is very true," says he, "that a species of 
deafness has been cured by perforating the membrana tym- 
pani, but in this case we cannot reasonably suppose that this 
membrane, indurated or changed in some degree, could either 
be capable of fulfilling the functions for which it is designed, 
or do otherwise than hinder the passage of sounds.*" 

for making a puncture in the tympanum. This first opening facilitates the 
entrance into the tympanum of the two little edges, which, being then drawn 
outward, cut the portion of the tympanum placed between them and the oblique 
extremity of the canula of which mention has been made. The two pieces 
are so adjusted that the edges of the mandrin glide upon the side of the canu- 
la along its whole length, in order that, issuing from the extremity of the 
latter, it may re-enter, acting with it precisely as do the two blades of 
scissors. The superior extremity of the canula is fastened to the body of 
the instrument where the mechanical part of it is, which I have said is 
very complicated. The instrument is contrived in such a manner, that 
when it is once accurately applied by its sharp, oblique face, to the septum, 
which may be cut without danger and conveniently fixed, the mandrin then 
descends by a rotary movement upon the membrane, a line and a third be- 
yond the canula, and returns by describing the same movement; this pro- 
duces a wound with a loss of substance, and the portion removed from the 
tympanum returns with the edges of the mandrin into the canula which 
receives them." 

The operation being completed, nothing more is to be done than to pre- 
vent inflammation, which might be developed within the cavity of the tym- 
panum. M. Deleau is very careful to place his patient in a situation where 
he will be but little disturbed by noise, to fill his cars with cotton, and to 
1 keep the head warm, by covering it with a handkerchief passed under the chin 
I and tied on the top of the head. For a few days he also causes him to avoid 
♦Diet, des; Sciences Mrdicales, t. 2, pp. 455 et 156, 

, 8 



k 



58 

The operation is to be preferred to all other means in the 
cases named by M. Savary, with which we have classed ossi- 
fication of that membrane. 

We will now examine those cases in which the operation 
has been successful, and which have been published in vari- 
ous journals. We will commence with those of Mr. Cooper. 

Case 1st. "A woman thirty-six years of age consulted me 
in December last, in regard to one of her children. In ques- 
tioning her, I perceived that she was deaf, to that degree that 
I had much difficulty in making her hear me. I questioned 
her in regard to her disease, and she informed me that her 
deafness became apparent after a very violent cold which she 
had had in the winter of 1793, and which had been accompa- 
nied with inflammation of the tonsils. I discovered that the 

any considerable motion of the jaws in masticating, and deprives him of 
cold drinks. It is, perhaps, owing to neglect of these precautions, that 
this operation has hitherto met with so little success. To prevent every 
kind of accident, would it not be useful, for the purpose of preserving the 
ear in its state of integrity, to adapt an artificial membrane to the bottom 
of the concha, which, in a very imperfect manner indeed, may supply the 
place of the membrana tympani, but which, by enclosing a cavity beyond 
that of the tympanum, may prevent the too intense impression of the air 
upon organs not accustomed to receive such an impression? 

The great advantage of the instrument of M. Deleau consists in its 
making a wound with loss of substance, so that its closure is impossible. 
But this operation has the inconvenience of being made without the sur- 
geon being able to direct it. He ought, it appears to me, to employ, very 
cautiously, an instrument which, once put in motion, proceeds to complete 
its revolution in a mechanical manner, and without being at all directed by 
the judgment of the operator; this apprehension is increased when we re- 
collect that the force is directed into an organ so complicated as that of 
hearing, and upon a membrane so delicate as that of the tympanum. 

It is expedient in surgical operations to employ, as rarely as possible, in- 
struments which are altogether mechanical. The knife, which is to divide 
the living tissues, and pierce the interior of our organs, should be confided 
to the hand employed by the skilful surgeon. Th. P. 



59 

disease proceeded from obliteration of the eustachian tube, 
and I proposed the operation to her. As she earnestly de- 
sired to recover her hearing, she submitted without hesitation. 
I performed upon her, at once, the puncture of the membrana 
tympani, in both ears, beginning with the left ear which was 
most diseased. As soon as the membrane was perforated, to 
the satisfaction of us both, she could hear perfectly every 
thing which I said in an ordinary tone of voice. She remain- 
ed with me half an hour, and on leaving me, her hearing was 
perfectly restored." 

It is obvious that, in consequence of a catarrhal engorge- 
ment of the throat and nasal fossae, the pituitary membrane 
which lines those and the interior of the eustachian tube, may 
be swelled — it may happen that mucous accumulates in the lat- 
ter, and that it even concretes there — swollen tonsils may com- 
press the tubes and mechanically produce deafness. All these 
causes whether they act separately or conjointly, w T ill give 
rise to difficulty of hearing, and even to deafness; but we can- 
not see how a catarrh and inflammation of the tonsils could 
occasion obliteration of the eustachian tube. 

Mr. Cooper says, "I discovered that the disease proceeded 
from obliteration of the eustachian tube." But obliteration of 
these cavities produces deafness more complete and absolute, 
as I shall prove in the course of this work. Now, according 
to Mr. Cooper himself, this woman still heard, therefore there 
was no obliteration. From this consideration, I deem it ne- 
cessary to remark, that Mr. C. has given no reason to substan- 
tiate his assertion. 

In the case under consideration, I am persuaded that hear- 
ing would have been restored with more certainty in regard 
to its continuance, the organ remaining untouched, by clear- 
ing away the obstructions of the eustachian tube, through the 
means of injections thrown into these canals by the way of 



i 



60 

the 'nasal passages, or by removing the pressure which the 
swelling of the tonsils might exercise upon the sides of the 
tubes, by producing resolution of those glandular bodies, by 
means which will be pointed out hereafter. 

Case 2d. "Anne Daley was admitted into Guy's Hospital, 
January 21, 1801. She was so deaf that she did not hear 
the strongest voice, although the mouth was applied to her 
ear. The disease was the sequel of certain ulcers of the 
throat. 

On the 25th of January, I performed the operation on the 
left ear, and it was scarcely finished when she could hear, at 
the distance of many feet, the beating of a watch, which, be- 
fore the operation, it was necessary to place between the 
teeth, in order for her to hear the beats. The next day I 
operated on the other side, in presence of Mr. Itocker, the 
apothecary of the Hospital, and many other professional gen- 
tlemen, who were acquainted with the cause of the deafness. 
The ear already operated on having been purposely filled, the 
experiment with the watch was repeated with the same suc- 
cess as the day before. In this woman, says Mr. Cooper, 
"the sense of hearing was completely restored, and has suffer- 
ed no alteration." 

This, it must be admitted, is an operation which, at once, 
does honour to surgery and to the operator. In the case in 
question, no one can doubt the closure of the eustachian tube, 
since complete deafness followed the existence of ulcers in 
the throat. The case belongs to the few in which it is pro- 
per to try perforation of the membrana tympani; nevertheless, 
I do not think that, hereafter, we ought, in the first instance, 
to perform the operation. We may, and we ought previously 
to endeavour to restore the organ of hearing to its primitive 
state, by opening the eustachian tubes, through the means of 
a process which I will describe in the first chapter of the 
third section. 



i 



61 

Case 3d. "I have bad occasion to see, in the course of the 
last month, a man who had received a violent blow on the 
head. He suffered all the symptoms of concussion, and a 
considerable hemorrhage occurred from the two ears, together 
with complete deafness. The symptoms, produced by the 
concussion were dissipated in a short time, but the deafness 
continued. I carefully cleansed the auditory passage of the 
blood with which it was filled, but without success. Suppos- 
ing then, that the tympanum might be filled with blood, 
which might obstruct the eustachian tube, I pierced the 
membrana tympani with a trochar. The point of the instru- 
ment was red when I withdrew it, and I saw, each day, a 
mixture of black blood and ceruminose matter, flow through 
the opening which I had made. The discharge continued six 
days, at the end of which the ear had perfectly recovered its 
fractions." 

The puncture of the membrana tympani, under these cir- 
cumstances, succeeded only because the blood still preserved 
a little of its fluidity. If this fluid had become concrete, as or- 
dinarily happens when it stagnates, the operation would have 
been fruitless; unless, indeed, injections had been conjointly 
used, as M. Itard employed them with so much success upon 
young Dietz, a deaf-mute. 

In the case reported by Mr. Cooper, injections through the 
eustachian tube would have had, over the perforation of the 
membrane, the double advantage of more certainly relieving 
the organ of hearing, and of leaving it uninjured. This as- 
sertion will be substantiated by facts. 

Case 4th. a Mr. Rooun of C," says Mr. Cooper, "consult- 
ed Dr. Bailey on account of his son, aged 17 years, who had 
been affected with congenital deafness, which rendered him 
unable to hear any thing. Dr. Bailey being assured that the 
auditory nerve was not affected, sent him to me. 



i 



62 

U I discovered that the disease proceeded from an unnatural 
formation of the fauces, and that, with him, the opening of 
the eustachian tubes did not exist.* The auditory nerves were 
sound, for he could hear the beating of a watch placed against 
the side of his head. He had never experienced any thing of 
vertigo or paralysis. I advised the operation, to which he 
willingly submitted. The moment the membrane was pierced, 
and air was permitted to penetrate the tympanum, he seemed 
animated with a new existence. The confusion of the infi- 
nite number of sounds, which all at once struck his ear, pro- 
duced in him such a sensation that he fainted. This state 
continued about two minutes, after which he expressed a wish 
that the operation might be performed upon the other side. 
This was done with the same success, and without his expe- 
riencing, in the mean time, the same fainting as before. Two 
months after I learned, with much pleasure, that he had ex- 
perienced no relapse nor any inconvenience in consequence of 
the operation." 

Mr. Cooper appears to me to be very indefinite in his ex- 
planation of the causes of deafness; he particularizes none, 
at least, in the translation which is found in the Bibliotheque 
Germanique. 

If, in the subject of the last case, deafness was caused by 
preternatural conformation of the fauces, and if, in him, the 
orifice of the eustachian tubes did not exist, then the perfora- 
tion of the membrana tympani was the only means to be tried. 

M. Michaelis wrote to M. Hunold that he had restored 
hearing to a lady by performing, without the least pain, the 
puncture of the membrana tympani, according to the method 
of Cooper. M. Hunold, after the assertion of M. Michaelis, 
resolved to try the same operation. 

* It is to be desired that Mr. Cooper had said how he was assured of the 
fact. 



63 

Case 1st. "A woman, forty-five years of age, had been 
deaf for ten years, in consequence of a violent inflammation 
of the ears caused by a severe cold. She heard none with the 
right ear, and scarcely any with the left. M. Hunold pierced 
the membrane on the inferior and internal part, (without doubt 
of the right ear.) The patient instantly heard all that was said 
to her, and declared that she experienced no pain, but only a 
cracking noise which was produced by the puncture." 

In this case, it appears that the right eustachian tube was 
closed by a cicatrix, the result of inflammation and ulceration. 
The perforation of the membrane of the tympanum, being 
found to be then the most advantageous means of restoring the 
hearing, we ought to employ it. 

This operation was by no means necessary on the left side, 
since the tube was not stopped, or but imperfectly so. Injec- 
tions, such as we propose, might have been employed with 
success, the deafness of that side, without doubt, proceeding 
from some obstruction in the eustachian tube. 

Case 2d. "A man perfectly deaf with the right ear, and 
who heard but little with the left ear, had had good hearing 
till the age of twenty years. While bathing on a day in sum- 
mer, he began to toy with his companions, and ended by 
fighting. In the midst of this strife, and while very warm, he 
plunged head-first into the river, from a high bank which bor- 
dered it. He was immediately taken out without signs of life. 
With much difficulty he was restored, but he remained deaf, 
notwithstanding the employment of many remedies which are 
proper for deafness produced by the sudden chill which he 
had experienced in falling into the water. The perforation of 
the membrane has restored his hearing." 

M. Hunold ascribes this deafness to the sudden chill which 
the patient had experienced in falling into the water. But 
deafness, under these circumstances, is only the secondary 



64 

effect of cold, admitting that this be the original cause of deaf- 
ness. What then should be the primary effect of the chill 
which the young man suffered, and which, according to M, 
Hunold, was followed by deafness? This could be nothing but 
paralysis of the acoustic nerves. Now the perforation of the 
membrana tympani cannot restore hearing, when the defect of 
this sense is owing to palsy of the auditory nerves. I am very 
far from thinking that M. Hunold practises any deception, in 
regard to the real results of the operation which he performed 
in this case; but I believe that he mistakes in regard to the 
cause of deafness. The young man had been plunged head- 
first into the river, he was taken out, at the same instant, 
without signs of life; he was restored with much difficulty. 
Who has not witnessed the effect of a violent disturbance of 
the cerebral mass, caused by a fall on the head, against some 
resisting body, and the deafness which followed it, the conse- 
quence of an effusion of blood or lymph, which takes place in 
the cavity of the drum and eustachian tube?* 

Case 3d. "A woman sixty-three years of age, deaf during 
thirty, in consequence of blows which she received from her 
husband, at least according to her declaration, heard with 
neither ear, which circumstance urged an operation on both 
immediately. This woman perfectly recovered the hearing 
of the left ear, and that of the right imperfectly, repeating, 
word-for-word, every question that was proposed to her." 

"The author," says the Journalist, "performed about a hun- 
dred other operations, of which two thirds were successful."! 

When a man thus exaggerates his success, he loses the right 
of being believed on his word, and destroys the confidence and 

* The author docs not say that any fluid escaped from the artificial open- 
ing, 

f Journal dc med. chirurg. pharm fey. 1793. 



.1 



65 

inclination of those, who might be disposed to examine further 
the facts which he alleges. 

M. Celliez, M. D. performed this operation on a woman 
fifty-nine years of age, deaf during twenty-two years, in con- 
sequence of an acute disease: The patient, according to the 
remark of the author of the case, had been always subject to 
catarrhal discharges, particularly to discharges of this kind 
from the head. 

"A careful examination of the ears having convinced me," 
says M. Celliez, "that the deafness depended on a stoppage of 
the eustachian tube, I thought that this was a proper case in 
which to practise the operation which Mr. Cooper advises. 
The fourteenth of November, the patient being conveniently 
placed, I took a trochar slightly bent, about fifteen millimetres 
in diameter, and the point of which passed beyond the canula 
about thirty millimetres. With it I perforated the membrane 
of the tympanum quite near its inferior and anterior edge. I 
had scarcely withdrawn it when the patient cried out, I hear. 
She remained some time, as it were, stupified and immovea- 
ble. Having asked her in an ordinary tone, if I had done 
her any harm, she answered no, and begged of me to speak 
lower. 

"After some moments of repose I perforated the other tym- 
panum. She could, immediately afterwards, hear every word 
that was spoken to her, but the noise troubled her a little, and 
it was with difficulty that she could bestow the attention ne- 
cessary to comprehend a discourse, or long sentence. 

"I performed the operation at the place directed by Mr. 
Cooper, to avoid touching the handle of the malleus; but more 
especially," says M. Celliez, "in order that the atmospheric 
air may acquire, by passing through the external auditory 
meatus, a temperature more uniform with that of the ear; for, 
continues the author, if the atmospheric, air be introduced di- 
9 



66 
rectly into the labyrinth,* it will be soon rarified, by the heat 
of the organ, and afterwards be displaced by a fresh column 
of denser air, a circumstance that will establish a kind of cur- 
rent, which will necessarily cause much pain. Finally, this 
place, it appears to me, ought to be selected for the puncture 
in order to avoid injuring the vessels and nerves of the tympa- 
num*, for although I am aware, that this injury is not usually 
attended by serious accidents, I think that a hemorrhage, 
however trifling we may suppose it, may furnish a clot suf- 
ficient for the obstruction of the opening made in the tym- 
panum; and may not the imperfect laceration of a nervous fila- 
ment occasion pain which it were more prudent to avoid?"f 

If M. Celliez had no other data by which to discover the 
obstruction of the eustachian tubes, than the examination of 
the external ear, strict as he supposes that examination to 
have been, he committed all to conjecture. 

The patient of M. Celliez became deaf in consequence of 
an acute disease; what that disease was, he does not say, but 
the author adds, that the patient was always subject to catarr- 
hal discharges from the head. This habitual indisposition was 
undoubtedly the principal cause of the stoppage or obstruction 
of the eustachian tubes in this woman. 

M. Celliez, to prevent the opening made in the membrane 
of the tympanum from closing, as often happens, thought 
proper to use a trochar of a diameter much larger than that 
pf Mr. Cooper's. I stated the accidents which might arise 

* The Author is mistaken; the air, in a state of health, does not pene- 
trate into the labyrinth; the foramen rotundum and ovale are closed he*, 
metically, and yield no access to this fluid; the labyrinth is filled with the 
lymph of cotunnus. M. Celliez means, without doubt, the cavity of the 
tympanum and the mastoid cells. 

f Journal de Medicine, Brumaire an. xiii. 



A 



67 

from the use of this trochar. I will finish this paragraph with 
the following corrallaries. 

1st. The perforation of the membrane of the tympanum 
is the only operation that is proper in a case in which this 
partition is cartilaginous or ossified, and in which the rest of 
the organ is healthy. 

2d. It will be employed with success, in stoppage of the 
eustachian tube, when it is impossible to remove this obsta- 
cle by the means which shall be pointed out and described 
hereafter, also when it is owing to mal-conformation, chronic 
swelling, or polypus in the nostrils. 

3d. This operation is insufficient, when the cavity of the 
drum is obstructed by matter which is so thick that it cannot 
pass through the artificial opening. 

4th. It will be useless when deafness depends on paralysis 
of the auditory nerves. 

5th. It will be equally so in case of deafness which pro- 
ceeds from catarrhal affections and nervous irritation. 

6th. When deafness is the consequence of adynamic and 
ataxic fevers, and the eustachian tube unobstructed, this ope- 
ration will be ineffectual. 

7th. Finally, this operation, excepting in the two first cases, 
ought to be rejected in the treatment of deafness. 



68 

CHAPTER VII. 

On rupture of the membrane of the tympanum. 

This membrane may be merely ruptured^ partly wanting, 
or completely absent. Several causes may produce a rup- 
ture of this partition, such as an ear-pick thrust in too far,* 
a violent inspiration^ sneezing,^ an erosion caused by pus;§ 
this last cause is the most frequent. 

Rupture of the membrane of the tympanum, from what- 
ever cause it proceeds, is easily ascertained: 1st, by the air 
which proceeds from the external auditory meatus with a 
whizzing sound, forming a current of air strong enough to 
move the hair or the flame of a wax candle, placed opposite 
and near the concha of the ear; 2d, if we pass an injection 
through the external auditory meatus, the liquid falls into the 
fauces, or passes through the nose; 3d, by injecting the eusta- 
chain tube, the liquid passes through the external auditory 
meatus. 

These are the means by which I ascertained it in several 
cases. 

The simple rupture of the membrane of the tympanum heals 
without the interference of art; this is proved by the experi- 
ence of Valsalva, of whom we spoke, page 53. M. Maunoir,|| 
according to the observation quoted on the same page, saw the 
opening that had been made in this membrane almost cicatrized 
twelve days after the operation. A person named C. on whom 
I practised Cooper's method of operating, experienced the 
same inconvenience. 

The partial destruction of the membrana tympani brings on 

* Riolan. t Duverney, Traite de l'organe de l'ouie, p. 178. 
| Tulpius, obs. 35, Verdue, Traite de physiol. t. 11, p. 102. 
§ Fabrice de Hilden, Sckinkius. 
fl Journal de Corvisart, Brumaire, ar. xiii. 



A 



69 

difficulty of hearing, but not the total loss of that sense. I 
could quote, in support of this assertion, several instances de- 
rived from my own practice. 

It is not so, however, when this membrane is entirely want- 
ing, because being intimately connected (in its healthy state) 
with one of the principal little bones of the ear, the articula- 
tion of this bone suffers considerably from want of support. 
This derangement of the malleus cannot take place without the 
other little bones, which are articulated with it, experiencing a 
relative change which will severely affect the faculty of hear- 
ing. We notice the opinion of a modern author on this sub- 
ject. "Nevertheless," says M. Leschevin, "whatever be the 
cause of the rupture of the tympanum, it is incurable; and it 
always induces deafness, if not at once, yet by degrees; how- 
ever, if this membrane be of no use, as some physicians have 
pretended, and among others Schelsammer, but to guard the 
internal ear from the injury of the cold air and exterior bodies, 
we might attempt to substitute an artificial membrane, but its 
connexion with the little bones and the other parts of the ear, 
convinces us that it is by no means useless in regard to the 
perception of sounds, and that the influence of the air would 
be ineffectual without it."* 

Art is ineffectual as well when the membrane is merely torn, 
as when it has suffered loss of substance. In the first case 
nature accomplishes the cure, and in the second the malady is 
incurable. 

I shall not recommend for the purpose of protecting the 
internal ear against cold air, and particles of foreign matter 
floating in the atmosphere, the insertion of a false membrane, 
as is suggested by Leschevin; a little wad of cotton lightly 
rolled and placed in the orifice of the external auditory foramen 
will be sufficient to remedy that inconvenience. 

J * Prix de TAcad royalc de chirurg t iy. in fo. 



SECTION II, 

On the diseases which AFFECT THE CAVITY OF THE TYM- 
PANUM, THE MARTOID CELLS, THE LITTLE BONES OF THE 
EAR AND THEIR MUSCLES. 

Catarrh; acute inflammation; suppuration; purulent infiltra- 
tion; caries; extravasation of blood; the accumulation of mucus, 
of ceruminose matter, and chalky substances, are affections 
which may assail the parts above mentioned. 



CHAPTER I. 

On Catarrh of the internal ear. 

This disease is an inflammation of the mucous membrane 
which lines the cavity of the tympanum. Sometimes it is 
merely a transient evil, and sometimes productive of serious 
mischief. Age, sex, temperament, errors in regimen, may, 
says M. Alard,* modify the disease and greatly influence its 
duration; hence the distinction between acute and chronic ca- 
tarrhs. 

The first, almost always belonging to infancy and youth, is, 
nevertheless, sometimes a disease of adults. The second, more 
common to all ages, more especially affects the aged. Atony 
of the lining membrane of the internal ear, proceeding from 
decay of the powers of life, gives origin in them to this in- 
firmity. 

The causes which giye rise to catarrh of the internal ear 

* Essai sur le catarrhe de Coreille Paris, 1803. 






71 

pre sudden variations of atmospheric temperature, as a sudden 
transition from warm to cold, from dry to moist; the suppres- 
sion of some accustomed evacuation, such as that of an ulcer 
or hemorrhoidal discharge; the repulsion of a scabietic humour 
or that of whooping cough.* In infancy the irritation of den- 
tition is often the cause of this disease, because that irritation 
determines an increased action in the head, which disposes all 
the organs which it contains to frequent morbid changes. 
Very many infants, deaf-mutes (in consequence of a catarrh of 
the cavity of the tympanum, or of the eustachian tube, or of 
some cutaneous eruption repelled upon the organ of hearing) 
for want of well directed attention are doomed to remain thus 
diseased during life because heretofore their infirmity has been 
regarded as a fault of original conformation and, as such, in- 
curable. 

The acute catarrh is characterized by extreme pain; never- 
theless M. Alardf thinks that when inflammation is confined to 
the cavity of the tympanum it gives but little pain, scarcely 
felt, "in the character of a slight tingling and an inconsidera- 
ble feeling of tension that the patient bears without inconve- 
nience." 

I am not aware whether M. Alard speaks from his own 
experience, but I can assert that I saw the contrary in several 
persons affected with catarrhal inflammation of the mucous 
membrane of the cavity of the tympanum; the pain was most 
severe, even to the termination of the disease. In relation to 
this subject I will relate two facts derived from my own prac- 
tice, not in order to invalidate the opinion of M. Alard, whose 
distinguished talents I respect, but to present a complete view 
of symptoms which characterise the species of affection which 
I describe. 

* Ouvrage cite. f Ouvrage cite. 



72 

D. a youth sixteen years of age, early in June, 1810, pro- 
ceeded early in the morning to drain some boats which were 
on the river Saone; he went into the water, with his feet bare; 
the morning was cold, and the work occupied him several 
hours. On leaving the water, he felt some chillness, and soon 
after the boy was affected with the following symptoms; pain 
and heaviness of the head, heat and painful tension of both 
ears, with a very troublesome tingling, difficulty of hearing, a 
darting sensation at first obscure. Soon these symptoms be- 
came aggravated in a violent degree; the fever became intense; 
the pains of the ear excessive; the least motion produced a 
ringing sensation in the parts affected, so that the young man 
suffered very much when he coughed, sneezed, or opened his 
mouth. On the third and fourth days, he had, from his nose 
and mouth, a considerable discharge of mucus and puriform 
matter; this evacuation afforded him a remarkable alleviation. 

A spare diet, diluent drinks taken copiously, leeches ap- 
plied to the side of the neck and near the ears, anodyne cata- 
plasms placed on those parts, were the means which I em- 
ployed to combat those affections, which yielded after a few 
days. 

M. A. a book-keeper of this city, aged fifty-nine years, was 
seized with difficulty of hearing, accompanied with a conside- 
rable degree of buzzing noise. He consulted me, the last of 
October, 1812. The atmosphere at the time was cold. # I 
threw injections of warm water containing ether into both 
ears, through the eustachian tubes. After employing these 
injections for some days, M. A. felt a painful tension in the 
interior of the left ear, a pain which increased considerably, 

* Cold and damp weather is unfavourable to the treatment of the organ 
of hearing by injections introduced into the interior of it. I have remark- 
ed this circumstance in several cases. 



73 

and extended to every part of the head: in a word, he had 
every affection of which I spoke in the preceding case. The 
particular circumstance attending the present case was a copi- 
ous serous discharge from the external auditory meatus. This 
discharge supervened from the third to the fourth day of the 
attack, so that the patient was affected at the same time with 
an external and internal catarrh; in fact he heard nothing with 
this ear. 

All these symptoms yielded to the means which we have 
mentioned in the preceding case. 

After the symptoms disappeared, the patient, by degrees, 
recovered the faculty of hearing as he enjoyed it before the 
employment of the injections, and the buzzing noise remained 
the same; a circumstance which seems to prove that this latter 
affection, as well as the deafness, was owing to injury of the 
auditory nerve. 

When a catarrhal inflammation attacks at once the cavity of 
the tympanum, the mastoid cells, and the eustachian tube, the 
symptoms are more severe: first, painful tension in the ear and 
fauces, spasms of the muscles of the head on the affected side, 
pain in turning the head, extreme dryness of the nose and 
mouth, darting sensations which extend from the tympanum to 
the pharynx, false or irritable hearing, a sympathetic pain in 
every part of the head, violent pain in the whole ear, finally, 
fever, restlessness, delirium, sometimes phrensy, an epileptic 
attack and death* Two cases borrowed from M, Alard's ex- 
cellent dissertation will confirm, in a great measure, the state- 
ment that we have made. 

"A girl after her tenth year, was in the habit of working 
lightly clothed, during summer, near a glass door which open- 
ed into a garden. 

? Duverney, traite de l'organe de l'ou'ire, Sauvages, nosolagie> t. 11. 

10 



74 

"She felt in the interior of her left ear (that which was to- 
wards the garden) a painful tension, which created a disagree- 
able feeling of restlessness, without amounting to pain strictly 
so called. The organ seemed to be insensible. 

"On the second day, this indistinct feeling of tension and 
numbness, changed into acute darting pains, which the patient 
compared to those which are felt during the formation of an 
abscess. 

"The third day, there was a little amendment. 

"On the fourth, the lancinating pains had subsided a good 
deal, but the ear returned to the same state in which it had 
been at the period of attack, and at that time the painful 
tension extended to the fauces. 

"On the following day, there were head-ach, spasms of the 
muscles of the back of the head, acute pain along the eusta- 
chian tube, difficulty in performing the rotary motions of the 
neck; finally, a feeling of erosion in the left side of the pharynx 
during deglutition. The perception of sounds had been con- 
fused for some days." 

The subject of the second case was a girl nine year sof age, 
who, in consequence of the sudden suppression of whooping 
cough, contracted a catarrh of the left ear. 

"The first day the little patient complained only of a sore 
throat and difficulty of swallowing. She, every instant, raised 
her hand to the ear, in which she experienced a troublesome 
itching. Her hearing was a little altered. 

"On the next day the symptoms had become more intense. 
The internal parts of the ear, and the whole left side of the 
head, were so painful that the patient knew not to what place to 
refer the disease which she suffered. There supervened fever, 
vertigo, and some degree of delirium, which continued till the 
night of the fourth day, when the disease was assuaged by the 



ID 

sudden expulsion of fetid matter which issued from the mea- 
tus auditorius." 

Chronic internal catarrh,* according to M. Alard, occurs 
with or without discharge. In the first case it is always the 
sequel of acute catarrh, and the matter which is discharged 
by the external meatus escapes from the interior of the ear, 
through a fistulous opening of the membrana tympani. This 
opening, together with the catarrh, produces a difficulty of 
hearing more or less considerable, but it is rarely followed by 
complete deafness. In the second case, it occurs sometimes 
in consequence of acute catarrh, at other times spontaneously, 
and it causes a great degree of deafness, but not perfect. 

"We meet with another kind of inflammation which," says 
M. Alard, "readily assumes the chronic character, and which 
is remarkable for the great quantity of mucus that it furnishes. 
This mucus, secreted in the tympanum, becomes so thick, that 
the whole of it cannot escape through the tube, and, finally, 
obstructs it completely. It causes a difficulty of hearing, 
which we frequently meet with, in a greater or less degree, 
according to the direction of the wind, or the state of the at- 
mosphere." 

"We meet with this disease sometimes in children," adds 
the author, "but it ordinarily afflicts persons between forty 
knd fifty years of age. It is the cause, as we have just stated, 
rf the majority of cases of deafness, so common in society, 
md which are regarded as incurable. They are, however, 
irery different from those which arise from injury of the audi- 
:ory nerves — they leave these nerves in a sound state, and on- 
iy present a mechanical obstacle to the perception of sounds."! 

It is true, that a chronic catarrh of the cavity of the tympa- 
i 

* Essai sur le catarrhe de Porielle. Paris, 1803. 

t Ouvrage cite. 



76 

num and mastoid cells, very often causes a superabundant ex- 
cretion of mucus, which, accumulating, causes deafness in a 
greater or less degree; but I do not think, with M. Alard, that 
this affection confines its influence "to the presenting of a me- 
chanical obstacle to the perception of sound, and that it al- 
ways leaves the acoustic nerves in a sound condition." I 
believe, on the contrary, that the frequent repetition of catarrh 
of the internal ear, also obstinate chronic catarrh, leaves the 
auditory nerves in a state of insensibility approaching paraly- 
sis. The following facts yield support to my opinion. 

C. a soldier, twenty-five years of age, discharged in conse- 
quence of being deaf, consulted me concerning his condition, 
in the month of September, 1813. His infirmity was the ef- 
fect of much exposure in the field. It had been preceded by 
pain in the fauces and ear, and by obstinate defluxions, with a 
copious excretion of mucus from the mouth and nose. All 
these symptoms disappeared; but he remained very deaf in 
both ears, particularly the left, with a very troublesome buz- 
zing noise. 

On the twenty-first of the same month I injected the right 
ear, through the eustachian tube; these injections were repeat- 
edly made with warm water to which I added some drops, 
either of lavender water, sulphuric ether, or tincture of musk; 
afterwards 1 employed warm Balaruc water. 

After a few days' treatment, the buzzing had considerably 
diminished, and the patient heard a little better with this ear. 
At the end of a month this young man heard very distinctly, 
when he was addressed in an ordinary tone, and the buzzing 
had ceased. 

It was impossible for me to inject the left ear: a polypous bo- 
dy situated in the back part of the nostril of the same side, 
presented an insuperable obstacle. Consequently, I determin- 
ed to puncture the membrana tympani, according to Cooper's 



J 77 

method, and I injected the ear through the external auditory 
meatus, with similar liquids. These liquids passed into the 
fauces, a circumstance which proves that the polypous did 
not perfectly stop the eustachian tube. After the tenth or 
twelfth day, the artificial opening was entirely closed. I per- 
formed the operation again with the modifications described in 
chap. vi. sec. 1. With the assistance of these means the arti- 
ficial opening was preserved; the patient hears a little w r ith 
this ear, but the buzzing remains the same. 

M. P. forty years of age, book-keeper of this town, was af- 
fected with difficulty of hearing, with a buzzing, in the left ear, 
and in the right with deafness and a similar buzzing. This in- 
disposition was the effect of catarrhal discharges from the 
throat, the nasal fossae, and the internal ear contracted in the 
field during the siege of Lyons. 

M. P. consulted me on the twenty-ninth of August, 1813. 
I advised him to submit his right ear only, to the treatment 
which I proposed. It was injected daily with the same liquid, 
and in the manner stated in the foregoing case. No injection 
was more effectual than the mineral water of Balaruc. After 
six weeks' employment of these injections, the buzzing had di- 
minished considerably and the patient heard very well with 
that ear. 

Before this treatment M. P. was affected with pain in the 
head and numbness, and the buzzing increased whenever he 
was engaged in calculation, which required some mental ef- 
fort; now he can exercise his mind without the least inconve- 
nience. 

A circumstance worthy of notice, is, that the deafness of 
the left ear, which progressed rapidly, had been arrested in its 
progress by the treatment of the right ear alone; a fact, which 
proves in an incontestible manner, the direct sympathy that 
exists between these organs. 



78 

From these two facts, we draw the following conclusions: 

1st. Chronic catarrh of the internal ear leaves behind it a 
difficulty of hearing more or less considerable, which, instead 
of diminishing, increases in course of time. 

2d. The deafness, which proceeds from chronic catarrh, 
does not always depend on mucous matter accumulated in the 
cavity of the tympanum, in the mastoid cells and the eusta- 
chian tube. This is proved by the facility with which the in- 
jections passed into those cavities in the subjects of the two 
cases which I have just related. 

3d. Catarrh of the cavity of the tympanum affects the nerves 
and the organs of hearing more or less; but this affection, 
though chronic, may be successfully treated by injections into 
the interior of the ear. 

Treatment of acute catarrh. — On the first appearance of the 
disease, we must oppose it by general remedies. Attention to 
diet, diluent drinks, bathing, pediluvium, blisters applied to the 
nape of the neck or between the shoulders, are the means 
which we ought to employ. The patient must avoid cold and 
damp air; the part affected ought to be kept in a state of mo- 
derate warmth. 

But if it should happen that a catarrhal humour accumulates 
in the cavity of the tympanum, we should employ a prompt 
and efficacious remedy. "The most urgent indication, in this 
case," says M. Alard, "is, to make a passage for the retained 
humour to escape." 

I am of his opinion, but we differ with respect to the means 
to be adopted in such a case. M. Alard advises the puncture 
of the membrana tympani. I am far from condemning this 
mode, but I would wish, before we had recourse to this ope- 
ration, to endeavour to discharge the humour contained in the 
cavity of the tympanum, by injections of warm water, passed 
through the eustachian tube. 



79 

This practice would have a double advantage, the removal 
of any obstruction of the eustachian tube and the rendering of 
the humour contained in the tympanum more liquid, and con- 
sequently facilitating its escape through the same tube. 

When the humour has escaped from the cavity of the tym- 
panum, either spontaneously, or by means of a passage made 
for it, the symptoms disappear, and nature is adequate to 
perfecting the cure. 

But if any circumstance causes the catarrh to assume the 
chronic character, or it spontaneously does so, we ought to 
adopt the following course. 

Injections slightly tonic, such as a weak decoction of cincho- 
na, infusion of mint water, to which are added a few drops 
of lavender water, cologne- water or sulphuric ether should 
be used. The mineral water of Balaruc, and that of Barege 
are equally proper in this case. 

M. Double* recommends a strong decoction of juniper ber- 
ries. He says that he employed them with success. 

Whilst we apply these remedies to the parts affected, we 
ought, from time to time, to stimulate the mucous system, 
by purgatives repeated according to circumstances; also the 
skin by sinapisms, blisters, the cautery, and setons. Hoffman 
cured a woman upwards of sixty years of age, by external topi- 
cal applications, and mild purgatives occasionally. 

He relates the history of a man, who, from the age of six- 
teen, was deaf in the right ear, and who, beginning to fear 
for the left, consulted him. I prescribed for him, says Hoff- 
man, a drastic purgative, which was to be taken in divided 
doses in the course of the week. The patient swallowed the 
whole at one time. This imprudence occasioned a severe 
cholic with alarming symptoms. During their continuance the 

* Journal de Med. Chirurg. Fharm- t xxxi. pp^ 40 et 41. 




80 

patient suffered excruciating pain in the right side of the 
head, principally around the ear, afterwards there was a con- 
siderable noise in that organ, and the hearing was perfectly 
re-established. 

This fact proves incontestibly that it is possible to cure deaf- 
ness of any contumance or degree, when it is the consequence 
of chronic catarrh of the internal ear, by exciting an irrita- 
tion on the mucus surface, remote from the seat of the mala- 
dy, as the two cases that I have related at page 73 and the 
following, sheWj also proving the good effects of baths intro- 
duced into the interior of the ear in the form of injection. 

Is it proper to attempt the cure of chronic catarrh? Two 
circumstances allow the interference of the physician, first, 
when the disease affects a young person, — however, we must 
attack the malady with caution, either establishing a blister or 
an issue, and permitting it to flow some time after the cure. 
The patient should be purged occasionally with the ordinary 
purgatives or the mineral waters. 

The second case in which we are permitted to attempt the 
cure of chronic catarrh, is when the disease is the conse- 
quence of some suppressed periodical or habitual evacuation, 

Frederick Hoffman effected cures by scarifying haemor- 
hoids and applying leeches to them. 

M. Alard* quotes the case of a young girl, the discharge 
from whose ear had been stopped by restoring the secretion 
of urine. 

A woman's ears had been discharging for six months in 
consequence of suppression of the menses. When they re- 
appeared, the purulent discharge from the ears ceased spon- 
taneously, 

Except in the two cases, which we have just noticed, it 

* Essai sur le catarrhe de l'oreille, Paris, 1803. 



) 

81 

would be imprudent to attempt the cure of chronic catarrh; 
the health and even the life of the patient might then be com- 
promised. 

The ancients, and after them Duverney, have remarked 
that similar cases were always followed by convulsions, epi- 
lepsy or death. 

Stalpart cites the case of a Venetian who had an old dis- 
charge from his ear stopped. Death was the immediate effect. 

Duverney states "that a man sixty years of age, of a full 
and sanguine temperament, had a very considerable discharge 
from his ears, particularly the right, during twenty-five years, 
although, in other respects he enjoyed good health. The 
matter discharged was fetid and very thick. This discharge 
being stopped, he died of apoplexy in twenty-four hours." 

M. Alard says "that an attorney in Paris* had an ear dis- 
charging matter copiously for a long time; the humour being 
repelled by cold, the ear became the seat of a violent inflam- 
mation, which induced very dangerous symptoms that were 
followed by death. 

"Similar events," the author adds, "should instruct us how 
attentive we ought to be in the cure of those diseases while 
recent, and how important it is to oppose the tendency they 
have to bocome chronic." 

* Duverney, Traite de l'organe de 1'ouie, p. 121. 



82 



CHAPTER II. 



On acute inflammation of the membrane which lines the cavity 
of the tympanum and the mastoid cells; and on abscess and 
purulent infiltration into the same cavities. 

The cause which produces catarrh of the internal ear, may 
in like manner induce acute inflammation, commonly termed 
otitis. When eruptive diseases, such as the small-pox, the 
measles, and especially scarlet fever, are opposed in their 
course, the morbid humour may be translated by metastasis, to 
the internal ear and produce serious consequences, as is ascer- 
tained by the following facts. 

M. D. of A. twenty-eight years of age, had been seized, at 
the age of fourteen, with scarlet fever, his mother who lived 
in some part of Lyons, came to bestow on him all the atten- 
tion of which maternal tenderness is capable. Her first care 
was to remove him from his boarding school to another dwel- 
ling. This removal caused a repulsion of the exanthematous 
humour which was translated to the throat and eustachian 
tubes; the consequence was inflammatory quincy, violent otitis 
and otalgia, or ear-ach, copious suppuration in every part of 
the internal ear, obliteration of the eustachian tubes, and total 
abolition of the sense of hearing. 

M. Ch** # of Marseilles, forty-years of age, had, at the age 
of nine, scarlatina anginosa, accompanied, as is generally the 
case, with inflammation of the fauces, which on the left side 
terminated in suppuration, the result of which was closure of 
the internal orifice of the eustachian tube, and complete deaf- 
ness of the left year. In the interior of the same ear, the pa- 
tient experienced only slight pain and no suppuration, a fact 
which lead to the presumption that the organ was susceptible 
of having its functions restored. 



83 

Symptoms. — Most«of the symptoms of catarrh of the inter- 
nal ear belong also to otitis, which is accompanied, among 
other symptoms, with fever, sleeplessness, often delirium, con- 
vulsions, and sometimes death, which, when the otalgia is ex- 
treme, occurs in a few hours. 

The rapid progress of the syptoms, their intensity, the keen 
and burning sensation which the patient experiences in the af- 
fected part, the cessation of mucous secretion in the cavity of 
the tympanum, the mastoid cells and the eustachian tube, and 
the dryness of the meatus auditorius externus, are signs which 
distinguish this form of inflammation from the catarrhal. 

When inflammation is about to terminate in resolution, the 
symptoms are less intense than when it terminates by suppu- 
ration or gangrene; they are gradually dissipated and when they 
have ceased, the organ of hearing perfectly recovers the inte- 
grity of its functions. 

Pulsatory pain, fever with chills, indicate that the inflam- 
mation is about to terminate in suppuration. If to those symp- 
toms there are added protrusion of the membrana tympani 
toward the external auditory foramen, and dull pains in the 
mastoid region, with oedema, these symptoms declare the exist- 
ence of a collection of pus in the cavity of the tympanum and 
in the mastoid cells. But the discharge of the matter through 
the external meatus, or through the eustachian tube removes all 
doubt in regard to it. 

When inflammation of the internal ear is about to terminate 
in gangrene, the symptoms become aggravated with incon- 
ceivable rapidity: a perfect alleviation succeeds them in an 
instant; but the face is soon covered with the paleness of death; 
fainting and hiccup alternate without interruption, and syn- 
cope terminates the life of the patient. 

Treatment. — As soon as the disease appears, we must act 
promptly and energetically; a short time will bring about the 



84 

cure or death of the patient. The physician ought never to 
lose sight of the exciting cause of otitis. To restore the ha- 
bitual discharges, the eruption which may have been suddenly 
suppressed, to re-establish the natural course of small-pox, 
measles, or scarlatina, are the first indications that demand our 
attention. 

At the same time, we should oppose the inflammation di- 
rectly, by bleeding from the arm, repeating it according to 
circumstances; by leeches applied to the side of the neck, 
near the affected ear, or on both sides, if both ears be affect- 
ed. A large blister should be applied between the shoulders. 
A spare diet, diluent drinks, emollient injections, sinapisms to 
the feet, emollient and anodyne cataplasms to the ear, baths of 
the vapour of milk and some emollient decoction, are direct 
means which are proper to be employed. We should be cau- 
tious in the use of the preparations of opium, whether given 
internally or externally applied. 

If the inflammation yields to the means which we have point- 
ed out, we should conclude the treatment with mild purga- 
tives, to prevent the chronic engorgement which often succeeds 
inflammation of the mucous membranes. 

If, notwithstanding this treatment, the pulsatory pain con- 
tinues and becomes more intense, we presume that the inflam- 
mation will terminate in suppuration. We are then to con- 
tinue the vapour bath, to apply the cataplasms before pre- 
scribed, or those made of sorrel leaves with lard, or lily root 
with fresh butter, but it is obvious how little influence these 
means can have on a disease so deeply seated. 

When we reflect on the structure of the soft parts which 
line the cavity of the tympanum and the mastoid cells, we can 
hardly conceive how any considerable abscess can form in 
merely a part of these cavities; it is more probable that several 
small ones exist at the same time, which, opening, furnish pus 



» 



85 

in quantity sufficient to fill these cavities, painfully distend 
the membrana tympani, cause it to protrude on the the side of 
the external auditory meatus, rupture it and establish an open- 
ing through this membrane. Then a perfect calm succeeds 
the violence of the disease. 

In this case there are two remedies which may be employed 
to abridge the sufferings of the patient, and arrest the painful 
efforts of nature — the puncture of the membrana tympani, and 
injections through the eustachian tube. 

This last remedy, I again assert, whenever it is practicable, 
will have: 1st, the advantage of preserving the integrity of the 
organ of hearing; 2d, of affording a passage to the pus, and at 
the same time cleansing the cavity of the tympanum and mas- 
toid cells, and thus accelerating the cure; 3d, of preventing 
the closure of the canal of the tube, nay, even its obliteration, 
which often happens as the effect of ulceration of that part in 
consequence of measles or scarlatina. 

The following are facts which strictly, and in every parti- 
cular, confirm the proposition (3d.) found in the preceding 
paragraph. 

Berthon D. aged eighteen years, was affected at the age of 
three years with an adynamic fever, the deleterious humour of 
which threw itself upon the throat and the ears. The patient 
bacame perfectly deaf, and consequently dumb, and in the 
right ear there took place an habitual discharge of pus which 
made its way through the external auditory meatus. The 
deafness was such, as the parents informed me, that the young 
person could scarcely hear, even in an indistinct manner, the 
most violent peals of thunder, or the firing of large pieces of 
artillery. 

I subjected this patient to the following treatment. The 
9th of May, 1813, I, for the first time, threw a warm injec- 



86 

tion of the water of Balaruc into the internal ear, by the way 
of the eustachian tube. 

The injection which I threw into the right ear, escaped 
freely from the external meatus, and brought with it a consi- 
derable quantity of pus. This circumstance, I confess, gave 
me a very unfavourable opinion of the condition of the organ. 
The next day I was informed, that, in the course of the night, 
the patient had discharged a still greater quantity of pus from 
the same ear, and that she had signified that she heard with 
that ear. Indeed it was apparent that she heard, because she 
gave attention when the hall-bell was pulled. I rang a bell 
near the right ear, and she made signs that she heard it. The 
same experiment was made upon the left ear, which had been 
injected, but the patient experienced no sensation. 

I injected the right ear again, but by the external meatus. 
The liquid passed almost entirely by the fauces. 

I injected both ears regularly every morning, through the 
eustachian tube. I also often injected by the external auditory 
meatus. 

After eight days of this treatment, the slight pain, which 
the patient had from time to time experienced, since the be- 
ginning of her deafness, ceased, and with it the discharge of 
pus from the right ear, moreover, the patient heard, very dis- 
tinctly, with that ear, the bell of a repeating watch. 

It was not till the fifteenth day of the treatment, that Ber- 
thon D ## * began to hear, with the left ear, the bell of the re- 
peating watch. Since that time the organ of hearing has ac- 
quired new sensibility and force. The young lady is attentive 
to the least noise which is made near her. 

On the twenty-fifth day, the patient heard the human voice, 
when she was spoken to in a tone a little above that of ordi- 
nary conversation. She even repeated some words, pronounc- 
ing them, however, very badly. For instance, in pronounc- 



i 



87 

ing Robert, she said and still says — To...ber, Jean — Za...nr, 
Pierre — ie...re; Francois — a...m...£ois; Roux — a..a..rou; pere — 
pe...e...re; mere — me...e...re, &c. She speaks in a high tone, 
and almost always when inspiring. There are many words 
that she will not repeat* 

At the end of a month from the commencement of the treat- 
ment, I discontinued the injections of the water of Balaruc, 
and substituted simple water, in which I dropped twenty or 
twenty-five drops of sulphuric ether to an ounce of water. 
These injections gave new energy to the organ of hearing; for, 
after using them for some days, the patient heard with more 

* I have lost sight of this young lady ami know not what progress she has 
has made in her pronunciation. 

The above is perfectly analogous to what is observed in deaf-mutes, who 
hear articulate sounds well, but whose hearing is not sufficiently delicate to 
distinguish the shades of difference. Thus, ba, da, ga, are with them the 
same as la, fa, pa; they confound poulet with foulet — daim with thyme — voeu 
with feu. It is the same thing with all sounds, the delicate articulation of 
which requires an experienced ear. 

But a phenomenon worthy of remark is that which I have often had occa- 
sion to notice, in the Deaf-and-Dumb Institution of Lyons. In the exercises 
which the professor causes his pupils to go through, in expressing the dif- 
ferent passions, they, in the dumb-shew by which they represent objects of 
fear, sometimes utter a cry which expresses, with surprising precision, the 
idea which affects them, such as an exclamation of wonder — of fear — of 
terror — of pleasure or of pain, &c. The euphonic sounds, uttered by the 
human voice, under these different circumstances, are not, as M. Itard as- 
serts, the result of imitation. Is it to be presumed that the class of half- 
deaf-and-dumb, to whom alone he appears to ascribe them, can distinguish, 
so well, sounds so transient, and utter them so correctly? I have heard, 
among others, the same cries uttered by those who were perfectly deaf, and 
in whom we cannot suppose them to have been the result of imitation. 
The explanation which M. Itard gives is very little satisfactory, and I 
believe it might with correctness be said, that this expression of the voice 
indicates a deep emotion, strongly felt — that it is the true language of the 
soul, and, as we may say, the cry of nature. 

I 



88 

clearness and much better. The song of a canary-bird (the 
bird was in an apartment quite remote from my office) sur- 
prised her very much. She stood motionless and listened 
attentively. Her countenance, animated and expressive, indi- 
cated perfectly that she heard, with delight, these melodious 
sounds. 

Finally, this young lady, after the fiftieth day, heard when 
one spoke to her in a low v1)ice in the ear; she heard very 
well, at a little distance, the beating of a watch. 

From the fiftieth to the sixtieth day, the organ of hearing 
remaining in the same state, I thought proper to discontinue 
the treatment. 

Loud noise fatigues, and e^en distresses her, but this slight 
inconvenience, which is not of long duration, is common to all 
those who, having been for a long time deaf, recover their 
hearing in a short time, or at once; for if the sense is gradu-? 
ally restored, it is certain that one would not experience that 
painful sensation, which, nevertheless, is only transitory. 

Berthon D. heard sooner with the right ear than with the 
left, although the deafness was equally complete in both. It 
is not difficult as I think, to ascertain the cause of this phenomi-- 
non. It was, as I believe, because in the left ear, the eustachian 
tube, the cavity of the drum, and perhaps the mastoid cells 
were obstructed by an earthy substance, hard, gray, and with 
difficulty detached from the cavities which it encrusted; while 
all the cavities of the right ear contained only matter which 
was not very hard, and hence easily permeable by the injec- 
tions. Besides, the perforation of the membrana tympani, by 
facilitating the evacuation of the pus, and of the injected li- 
quid, contributed much to the prompt removal of the obstruc- 
tions and to the cure of the right ear. 

It is a singularity worthy of remark, that the individual 
heard better with the right ear than with the left, although the 



89 

membrana tympani was in part deficient in the former. This 
tends to prove what many authors have asserted, that the in- 
tegrity of that membrane is not indispensably necessary to the 
organ of hearing; provided, however, I would add, that the 
solution of continuity does not take place at the spot where 
the malleus is attached; for I think that if this bone were dis- 
placed, it would produce deafness, by the subsequent injury of 
the other bones of the ear; an injury which the lesion of the 
first would inevitably produce. 

I here anticipate a question which may give occasion for 
censure, if I do not hasten to reply to it with arguments 
which I believe to be conclusive. 

The membrane of the tympanum being open, I am asked 
of what utility it can be, to convey deeply into the nose, along 
parts of exquisite sensibility, an instrument for injecting the 
internal ear, whilst there is, in the external auditory passage, 
a more direct avenue, to enter which is less painful and less 
1 difficult? 

However obvious may be the justness of this reasoning, 1 
would observe that, in the right ear, the principal source of 
I the suppuration was in the mastoid cells, which fact was made 
I manifest by the dull pain in that region. My object was to. 
drain the source of suppuration. Had I injected this ear only 
j by the external meatus, could I have attained my object? I 
1 cannot think so; (a single anatomical examination confirms me 
in my opinion.) By injecting through the eustachian tube I 
throw the remedy as directly into the mastoid cells, as into 
the drum of the ear, As to the operation, it is neither diffi- 
cult for the operator, nor painful to the person who suffers it* 



, 



* What our author here says, in relation to the facility of introducing 
the instrument into the eustachian tube, and the little pain which is produ- 
ced by injecting through that canal, does not harmonize with the statement 



90 

The following case goes to prove that which I have just 
stated, in regard to the insufficiency of injections through the 
external auditory meatus, in case of suppuration in the mas- 
toid cells. 

Miss B. seventeen years of age, was affected in her infancy 
with a strumous habit, of which she bears marks on the sides 
of the neck. The organ of hearing suffered most severely 
from it. Distressing pains, purulent collections in the cavity 
of the tympanum, rupture of the membranae tympani of both 
ears, chronic suppuration, and very considerable difficulty of 
hearing, were the effects which this disease produced. 

Upon this young lady there was bestowed all the care and 
attention which the tenderness and wealth of the parents could 

of M. Itard, in his treatise on the diseases of the ear. "The introduction 
of the sound," says that author, "produces, in some persons, a tickling sen- 
sation in the interior of the nose, so intolerable, that it is necessary, by 
frequently repeating the attempt, to gradually familiarize the pituitary 
membrane to the contact of the instrument." Besides, he speaks of ce- 
phalalgia, vertigo, giddiness, and syncope, as being produced by these in- 
jections. This diversity of opinion, and such different results, proceed un- 
doubtedly from the slight resemblance between the two instruments em- 
ployed by these two operators. The shaft of M. Itard's instrument, is 
straight, and has only a slight curvature at the guttural extremity which 
terminates in a point. That of Saissy on the contrary is rounded at the 
same extremity, and has many curvatures which accurately correspond to 
the windings of the nasal channel. The instrument is so constructed that 
the operator with great facility enters the eustachian tube, without injuring 
the membrane which lines these cavities, when one has become accustomed 
to performing the operation, as I have recently satisfied myself, having had 
occasion to perform the experiment many times. The same advantages do 
not belong to the method of M. Itard. It is impossible that a straight 
sound can traverse all the windings of the nasal channel, and enter the gut- 
tural orifice of the ear, without lacerating, more or less, the pituitary mem- 
brane and the nervous filaments which are there present, and without en- 
dangering the delicate plates of the turbinated bones, circumstances which 
may produce tlie accidents of which M. Hard speaks. Tlr P, 



91 

cause to be rendered by the most learned of the profession. 
Among the numerous remedies which were used, the mineral 
waters of Aix in Provence, and of Balaruc, taken upon the 
spot, administered internally and applied externally by bathing 
the ears, and introduced in the form of injections into the ca- 
vity of the tympanum, through the external auditory meatus, 
appeared to have removed the strumous habit, Without doubt, 
the age of puberty had much influence in producing this result. 
The young lady was, however, still affected with a suppura- 
tion in both ears, pains in the head which were felt in the mas- 
toid regions, troublesome itching in the cavity of the tympa- 
num and the mastoid cells; and, what was much more afflicting, 
' the difficulty of hearing increased in spite of the injections of 
the water of Balaruc and a blister on the arm that she had 
worn from infancy. 

The parents, despairing of seeing any termination of the dis- 
ease, resolved to bring their daughter to this city. One of our 
most skilful physicians rendered her for some time the most 
judicious attentions, but, like every thing else which had been 
employed, they were unattended with success. 

On being consulted in regard to the condition of this young 
lady, I judged, from the health which she appeared to enjoy, 
that the disease was local. M. M* # * Jim. and myself deter- 
mined that I should inject the ear by the eustachian tube. 

On the 20th of Oct. 1813, I commenced the treatment with 
the water of Balaruc. Injections thrown into the right ear is- 
sued from the meatus externus, and with them, a considerable 
quantity of pus. The injections which I threw into the left 
eustachian tube, did not issue by the external ear, but escaped 
from the mouth and nose in a turbid state, which showed, as 
in the right ear, a collection of pus in the cavity of the tym- 
panum and the mastoid cells. 



/ 






92 

After employing the injections for fourteen days, the pain in 
the head, the suppuration, and the difficulty of hearing had sen- 
sibly diminished; but the severity of the season rendered it ne- 
cessary to discontinue the treatment. 

These facts are sufficient to show at once the insufficiency » 
of injections thrown into the interior of the ear, through the 
external auditory passage, and the efficacy of those which en- 
ter the same organ by way of the eustachian tube. 

The celebrated Jean-Louis Petit,* speaks of an abscess in 
the internal ear, in regard to the existence of which the fol- 
lowing phenomena are conclusive; 1st, its suddenly bursting 
through the external ear; 2d, the successive discharge of the 
small bones, and of fragments of the bony circle of the audi- 
tory passage and of the foramen ovale, caused by the use of 
injections for fifteen days. The patient lost the faculty of 
hearing in that ear. 

Might we not obviate these accidents by seasonably intro- 
ducing into the internal ear emollient anadyne injections, and, 
after these, those which are detergent? In this case, in em- 
ploying the mode of injecting which we propose, the injection 
ought to be passed with particular care to avoid irritating the 
inflamed and painful parts. 

Duverney has opened the ears of many infants after death in 
whom the tympanum was filled with pus. "It has occurred 
to me," says that author, "in studying the ear, to have often 
found the tympanum, the vertibule, the semicircular canals, 
and the cochlea entirely filled with thick matter, which may 
have been the consequence of an abscess of the membranes ' : 
that line those parts. I am confident that this, as well as the 
collection of other humours which may take place in those 
cavities, often causes deafness."f 

* Petit, (Euvres posthumes, t. 1. 

f Duverney, traite de l'organe de l'ou'ire, p. 151 et 152. 



, 



J 

The following facts^ in some measure , support (he conjec- 
tures of Duverney. 

Ther***, hair-dresser of this town, thirty-two years of age, 
had, during four years, slight pains in the ears with itching and 
suppuration. He often blew bloody pus from the nose, some 
degree of buzzing had preceded the pain and suppuration; dy- 
secee, or difficulty of hearing, followed, and became so intense 
that the patient scarcely heard a person speaking in a very 
high tone. He did not perceive the beat of a watch but when 
placed on the concha of his ear. 

On the eleventh of May, 1815, I commenced the treatment. 
Injections of Balaruc water, conveyed into the interior of the 
ear through the eustachian tube, at first caused a considerable 
quantity of pus to escape. The injections of the left tube es- 
caped by the external auditory meatus, bringing with them the 
pus, which had been contained in the cavity of the tympanum. 

The employment of these injections, during five or six days, 
enabled the patient to hear very well, when he was addres- 
sed in the ordinary tone, at the distance of from eight to ten 
paces, and the beats of a watch fifteen inches from the ear, but 
after the twentieth visit the buzzing and suppuration ceased, 
the cure appeared complete and the hearing re-established, at 
least as perfectly as the nature of the disease and the affection 
of the organ would permit. 

Three mild purgatives were administered in the course of 
the treatment. This man had had, during several years, an 
issue in his left arm, which I advised him carefully to preserve. 

This prompt restoration of the hearing was owing to the 
character of the proximate cause of the deafness, and to the 
treatment which was adopted. It does not require, it seems to 
me, much sagacity to perceive that thick matter (which fills 
the cavity of the typanum and glues together, if we may use 
the expression, the little bones of the ear, the membrane of the 



94 

tympanum, and that of the foramen ovale) is very well calcu- 
lated to suspend, and even to destroy the faculty of the organ 
of hearing. It is easy to conceive also, that a process which 
washes the parts directly, is very sure promptly to disengage 
the thick and even solid matter which obstructs them. 

The following case is perfectly similar to the preceding, ex- 
cept in regard to the cause: 

The daughter of Madame, widow V. grocer of this town, 
fifteen years of age, had been subject in childhood to an erup- 
tion on the head; about the twelfth year this eruption disap- 
peared, but near that period, the patient experienced pains and 
buzzing in the right ear, with itching and a discharge from the 
external auditory meatus, and sometimes when blowing the 
nose she discharged pus. 

The difficulty of hearing was at first inconsiderable, but this 
infirmity progressed daily, so that on the 14th of September, 
1815, (the day on which I began the treatment), this young 
person did not hear with this year except she was addressed 
in a loud voice and quite near. She did not hear the sound of 
the stroke of a watch but when it was applied to the concha 
of the ear. 

The first injections, passing from the mouth and nose were 
turbid with the pus which they brought with them. If I pres- 
sed the piston of the syringe a little more than usual, some 
drops of the injection escaped by the external auditory meatus, 
which proves that ulceration of the membrana tympani existed; 
however, this solution of continuity must have been extremely 
small, since I could never discover it, and it became closed du- 
ring the treatment, and the injections ceased to pass through 
the external auditory meatus, though they were injected with 
a degree of force. 

The discharge from the cavity of the tympanum and from 
the external auditory meatus ceased about the thirty-fifth day; 



; 



95 



however I continued them to the fiftieth. Two purgatives 
were administered at the conclusion of the treatment. 

After the first injections the patient heard the beats of a 
watch at a foot's distance from the ear, and now hears them at 
more than the distance of two feet. If, after having stopped 
the left ear, she is spoken to in the ordinary tone at the dis- 
tance of some paces, she hears very distinctly. She hears 
very well also if addressed in a low voice and near. 

On abscess of the Mastoid Apophysis. 

"Abscess of the mastoid apophysis," as is observed by Cho- 
part and Desault, "forms a tumour more or less apparent, al- 
ways slow in its progress, and accompanied with pulsatory pain 
and fever. It opens into the drum and the pus issues from the 
tube or ear, after having penetrated the membrana tympani. 
Sometimes the tumour extends behind the ear, with swelling, 
hardness, pain, and very little fluctuation. After the opening 
of the abscess, a fistulous ulcer is established which is often 
incurable, when the carious bone- has not been discovered. 
At another time the pus, after forming a passage through the 
auditory meatus, issues from the ear without injuring the mem- 
brana tympani."* This last forms an external abscess of 
which we do not design to treat. 

Abscess of the mastoid cells is often the consequence of the 
venereal disease. The celebrated Jean-Louis Petit quotes se- 
veral instances. A scrophulous taint, the suppression of an 
habitual discharge, likewise a blow, a fall on the head, may 
cause it. 

The symptoms which characterize this abscess are a gravi- 
tating pain in the interior of the mastoid apophysis, soft swel- 
ling, a slight inflammation in the skin which covers the part. If 

* Choparl et Desault traite des malad. chir, t. 1. 



96 

the pus has passed through the external osseous lamina there 
will be fluctuation. 

This affection is always very severe, and the life of the pa- 
tient is often in danger; besides, when the abscess forms a pas- 
sage through the osseous lamina, which covers the mastoid 
cells, the patient generally is deprived of the use of his ear, in 
consequence of the ravages which suppuration and caries will 
have made in the interior of the organ. 

Caries almost always accompanies these deep and long con- 
tinued suppurations; then the cavity of the tympanum may be 
affected singly, or together with the cellular lamina of the 
mastoid apophysis; this last is generally implicated owing to 
its peculiar structure. 

We discover caries 1st, by the local pain which the patient 
experiences; 2d, by the symptoms which may have preceded; 
3d, by the nature of the pus which issues from the ulcer, this 
is ichorous, has a very fetid odour, and stains of a black hue, 
silver forceps and sounds, as well as portions of the dres- 
sings. 

Nature very seldom can accomplish the cure of this disease- 
however, Leschevin* relates the case of a girl, in whose ears 
humours collected in consequence of a malignant fever. One 
of the collections made its way through the auditory meatus, 
the other penetrated into the mastoid cells, wasted the bone, 
and formed an opening behind the ear. The carious bone ex- 
foliated, the ulcer healed, almost without the use of any reme- 
dies, and the little patient enjoyed the hearing of that side. 

This was an extraordinary effort of nature which it would 
be imprudent to depend upon in cases of which we treat. 

We should open the abscess as soon as it becomes manifest, 
in order to arrest the progress of the injury which the bone 

• Prix de TAcad royale dc chiturg 



J 

97 

suffers. We may employ the caustic, when the disease is the 
result of a critical or chronic deposition; in other cases we 
should expose the bone by a crucial incision and by turning 
back the extremities of the flaps. Afterwards we should apply 
spirituous desiccatives, such as the commander's balsam, the 
balsam of Fioraventi, camphorated spirit of wine, or mercu- 
rial water, if there exists caries which is not deep; otherwise 
the actual cautery will be preferable, for we can limit its ef- 
fects at pleasure. When the abscess has opened spontaneous- 
ly, we ought to enlarge the fistulous opening, in order to de- 
nude the bone, to give issue to the pus, and facilitate exfolia- 
tion. 

Detergent injections through the artificial opening, and 
proper dressings, will complete the cure if this disease be 
merely local; but if the abscess be- owing to a syphilitic or 
strumous taint, it will be indispensable to combat this at the 
same time. 

The following case very well illustrates the disease of which 
we treat, although we do not report all its details: 

"A soldier complained of a discharge from his ear. He 
heard with his right ear with great difficulty, and not at all 
with the left for about four years from the time that, a putrid 
ulcer which was on his right leg having healed, the running 
from his ear had commenced. This matter was very fetid, and 
the patient occasionally experienced severe attacks of fever, 
accompanied with violent pains, particularly in the right ear. 
These symptoms were alleviated by blood-letting, laxative and 
refrigerant remedies, and the application of topical emollients 
and anodynes. These symptoms returned frequently and were 
always treated in a similar manner. The patient came to the 
hospital again in 1766. He had a violent fever, and extreme 
pain. He was bled three times in the space of two days; we 
employed gentle laxatives and emollient injections, and vapour 
13 



98 

baths io the ear; blisters were placed upon the nape of the 
neck, and behind the ears, and leeches applied. Ml these 
means were successively used and repeated several times. 
None of them however relieved him. 

"The patient continuing to suffer and being without sleep, 
we were obliged occasionally to administer opium; a quantity 
of ichorous and fetid matter issued from the right ear, and 
when we pressed the external opening, thick and granulated 
pus often escaped. At the termination of three weeks we 
perceived a soft elevation on the mastoid apophysis. We then 
applied emollient cataplasms and the tumefaction disappeared 
on the following day. We applied to its seat basilicon oint- 
ment, blended with powder of cantharides. Some days after, 
it again appeared. During this time the fever had been more 
or less high, according to the severity of the symptoms, and 
the pain continued to be insupportable. We determined 
at last to make an incision in the tumour an inch long. A 
few drops of a thin and acrid humour and nothing more issued 
from it. We persisted in the application of emollient cata- 
plasms in the hope of relieving the pains, but they continued 
as intense as usual. Whilst dressing it, M. Jasser (the author's 
name) remarked, on the lint, a black stain, which caused him 
to suspect caries of the bone. The membranous expansion, 
and the periosteum which covered the mastoid apophysis, were 
detached; and the bone having been exposed, we introduced a 
sound into the cells of that apophysis. 

"A pectoral infusion, nothing else being at hand at the time, 
was injected through the opening, by means of a syringe, 
whose canula exactly filled it, but, to the great astonishment of 
the physician and patient, (the editors say,) all the injection is- 
sued instantly from the right nostril. The pain abated, and the 
wound being dressed in the dry manner, the patient went to 
bed and slept profoundly during the following ten hours. 



99 

Though he had slept on the right side, very little matter es- 
caped from the right ear. 

"After dinner, the dressing was renewed, and the same injec- 
tion repeated. The pain had ceased and the patient experi- 
enced only at intervals some transient pain in the ear. The 
discharge from the right ear diminished daily, the odour and 
the colour of the matter became better, and in eight days he 
had neither pain nor discharge. 

"The injections were then discontinued and the wound dres- 
sed with dry lint only. The bone was kept some time still 
exposed; but as no more sanies proceeded from it, a cicatrix 
was permitted to form, which was completed in about three 
weeks. 

"This success (continues the editor of the Journal, from 
which we learn the fact,) induced M. Jasser to attempt the 
cure of the deafness, by making an artificial opening on the 
mastoid apophysis; consequently he operated on the left ear of 
the patient in the following manner. 

"He made, in the skin, an incision which penetrated to the 
bone and exposed it to the extent of half an inch. He after- 
wards perforated the mastoid apophysis near its middle; then 
he introduced into this opening the point of a small syringe, 
by means of which he injected a decoction, in which a little 
myrrh had been dissolved. This injection issued from the left 
nostril. These means being daily repeated, during four days, 
the patient declared that he heard with the left ear. The re- 
medies being still continued for some time, the patient conva- 
lesced gradually; however, the hearing of the left ear was not 
so completely re-established as that of the right. In three 
weeks the wound, which was always dressed in a dry state, 
healed without any exfoliation of the boue. From that period 
this soldier enjoyed good health and felt no pain in the ear."* 

* Journal dc Med. Cliirurg, et Tharm. fey. 1793= 



100 

These observations present several points which merit an 
attentive examination. We will direct our attention parti- 
cularly to the operation which was performed on the left 
ear, and will give a brief historical review of it. We shall 
speak of its advantages and of those cases in which it ought to 
be employed, to the exclusion of every other operation. We 
will not omit mentioning the serious inconvenience which re- 
sults from it in all cases except those, or rather the single case, 
which requires it imperatively. 

As the ear-ach, which tormented this young soldier during 
four years, was caused by the drying up of an ulcer of a bad 
character, the principles of sound practice, would suggest to 
us the propriety of establishing a copious suppuration in 
the part where the ulcer had existed. By this means, the 
patient would have been exempted from long and severe pains, 
and would not have risked, without the hope of recovery, the 
use of the organ of hearing and even his life. Even supposing 
that the re-establishment of the ulcer had not arrested the pu- 
rulent discharge from the ear, it would have always served as 
a drain, which would have permitted the surgeon to attack di- 
rectly the disease of the ear, without exposing the patient to 
the severe symptoms which had nearly destroyed him. We 
shall substantiate this assertion as we proceed, by instances 
derived from authors the most worthy of our confidence. 

Otalgia, in the above case, is often assuaged by emollients, 
soothing remedies, and blood-letting, but the disease in its pro- 
gress produces deafness, because every time that it recurs the 
accompanying symptoms are more intense. 

Matter, then, makes its way through the membrana tym- 
pani, but undoubtedly by an opening very small, since there es- 
capes merely a thin humour, ichorous, and very fetid — circum- 
stances which indicate the presence of that humour in the ca- 
vity of the tympanum } and in the mastoid 06118= It is only when 



J 

101 

one presses upon the orifice of the external meatus that there 
sometimes escapes a thick and granulated pus. 

Finally, the last paroxysm is more protracted and violent. 
The remedies which had been before employed are repeated 
without success. New means are resorted to, such as emol- 
lient injections and baths of vapour conveyed into the auditory 
meatus, blisters on the neck and behind the ears,* leeches to 
the latter places; but none of these means assuage the disease. 
The pain becoming more intense, and sleep being interrupted, 
opium is resorted to; a dangerous remedy in inflammatory dis- 
eases, especially in those of an organ so sensible and so deli- 
cate as that affected in the present case. 

At the end of three weeks a soft tumour is perceived behind 
the ear, upon the mastoid apophysis; poultices are applied 
which, however, do not prevent its disappearing, to return af- 
ter a few days. The fever is intense and the pain intolerable. 
It is determined, at length, to make an incision into the tumour 
an inch long. Nothing escapes from the opening but a few 
drops of a thin, acrid humour. 

It is evident that this humour came from the mastoid cells, 
after having passed through the pores in the osseous lamina 
which covers them. It then occurred to the surgeon to en- 
large the incision in two directions, to expose the bone and 
to perforate the mastoid apophysis to the source of the pus, 
which was the essential cause of all the sufferings of the pa- 
tient. The application of emollient cataplasms was continued 
in the vain hope of allaying the disease, but the pains continued 
to be as severe as before. It was not till black spots were 
seen upon the lint with which the part was dressed, that caries 
of the bone were suspected. It had made such progress, that 
the probe alone sufficed to penetrate the cells of the mastoid 
apophysis, and to make an opening large enough to admit the 

* We have shown elsewhere that this practice is injurious. 



102 

tube of a syringe. The pain ceased after the first injections, 
The discharge from the right ear diminished from day to day, 
and at the end of eight days there no longer existed any pain 
or discharge, and, in the space of three weeks, the patient was 
completely cured. 

It is almost unnecessary, after all that we have said, to re- 
mark that as soon as the injections had entered directly to the 
source of the purulent discharge, the pus changed its charac- 
ter, the ulcer was deterged, and the cure promptly effected^ 
without subsequent mischief, although the case is dated four 
years after.* 

The means which I shall recommend in a similar case are: 
1st, the re-establishment of the ulcer, 2d, emollient injections; 
then, those which are detergent, not by the external meatus, 
(we have just noticed the little success which attended them,) 
but by the eustachian tube. These injections, by expelling 
the pus from the cavity of the tympanum and mastoid cells, 
drain the source of it, and the cure is as speedy as it is certain. 
The case which we have reported, together with examples 
drawn from my own practice, furnishes proof complete of what 
I assert. 3d. Some time after the cure of the ear is accom- 
plished, the ulcer should be cicatrized, every precaution which 
art can dictate being observed, to protect the patient from ul- 
terior accidents, of which we have adduced instances. 

The idea of perforating the mastoid apophysis was conceiv- 
ed long before it was done by M. Jasser. Riolan proposes 
in many passages of his writings and particularly in his opus- 
cules anatomique, to perforate the mastoid apophysis with a 
very small stylet, in certain cases of deafness, and in ringing 

* This fact, and those which 1 have reported at page 76 and the follow- 
ing, lead me to believe, that it is less dangerous to suppress chronic issues 
of pus, of any kind, in young persons than in those more advanced. 



103 

and buzzing of the ears, when these affections proceed from 
an obstruction of the eustachain tube. 

Rolfimius advises to open this apophysis with a trochar, in 
case of dropsy of the cavity of the tympanum and the mas- 
toid cells. Another author, according to Sauvages, advises 
that it should be practised pro educendis Jiatibus in aure tu- 
multuantihis, (for evacuating flatus producing disturbance in 
the ear.) "These authors," Sauvages properly remarks, 
"should substantiate their opinion by observation, or they 
should not hazard advice which appears at least useless."* 
lie might have said dangerous as we shall prove below. 

It appears that M. Jasser was the first who has practised 
this operation, and that M. Hogstaens followed his example; 
but the attempt of the latter was not fortunate, for, besides 
that the patient did not recover his hearing, he encountered a 
considerable hemorrhage, which hindered the accomplishment 
of the operation. The injections which were employed gave 
rise to severe and uncommon symptoms. Every time that the 
injection was thrown in, the patient complained of agonizing 
pain in the head, and of buzzing noises in the ear. What was 
most surprising, however, was that he lost his sight, experien- 
ced a degree of suffocation, and fell into a swoon; but, says 
the author, all this endured but for a few minutes. I think 
that the length of time was sufficient to endanger the life of 
the patient. The injections fairly entered the mastoid cells 
but no part of them issued, either by the mouth, the nose, or 
by the external auditory meatus.f 

M. Lofffer has also performed this operation in a case of 
deafness caused by the translation of a morbific humour to the 
ear. The injection did not pass out through the mouth, but 

* Sauvages. Nosologie, t. ii. note de la p. 219. 
t Journal de Med. Chirurg. et Pharm. fev. 1793. 



104 

the patient recovered his hearing. He lost it again, however, 
when the wound healed. "In consequence of this," say the 
editors of the journal from which we quote the case, "M. 
Loffler resolved to open the mastoid process again, and to 
make an artificial canal, of the diameter of a writing quill, 
keeping it open by introducing a piece of cat-gut. The suc- 
cess was such that, at length, the patient heard through the 
opening established in the mastoid apophysis, as well indeed 
as before these means were employed. He heard when he 
opened his mouth, and when the sound was transmitted by 
the medium of the eustachian tube. It appears that, in this 
case, the cause of deafness was in the membrana tympani, or 
in the vicinity of that membrane."* 

The cause of deafness, in this patient, was in the eustachian 
tube, and no where else. If that passage had been free, as 
the editors of the journal suppose, the injections which were 
thrown into the mastoid cells, would have passed into the fau- 
ces and the nose, which, however, did not occur. 

The patient, say they, heard better when he opened his 
mouth, but this is no proof that the eustachian tube was free, 
since we may assign a reason for that phenomenon, indepen- 
dent of the eustachian tube, with which indeed it has no con- 
nection. 

It is undoubtedly true, that we hear better when the mouth 
is open, but is it because, at the instant, the eustachian tube 
receives an increased quantity of the rays of sound, which di- 
rectly impinge upon the organ of hearing? Or rather, as ap- 
pears more probable, is it because, the mouth being open, 
the external auditory meatus is more expanded, and less tor- 
tuous? To convince himself of the truth of this assertion, 
any one may make upon himself the following experiment. 

* Ouvr. cite, fev. 1793. 



105 

The mouth being open, introduce, as deeply as possible, 
the point of the little finger into the external auditory passage; 
then shut the mouth, and you will perceive the finger to be 
slightly compressed. Now this compression is produced by 
the condyle of the lower jaw, which tends to press together 
the walls of the meatus when the mouth is shut. If then we 
hear better when the mouth is open, I again assert that it is not 
because the eustachian tube conveys additional rays of sound 
(undulations) to the immediate organ of hearing, but rather be- 
cause the external auditory meatus admits a larger column of 
those rays. 

The eustachian tube* is essential to hearing, But it has 



* M. Perole has proved, by experiments, published in the memoirs of the 
Societe Royale de Medicine de Paris, for 1779, that the eustachian tube is 
not a passage by which sounds are transmitted. A single and simple ex- 
periment confirms this assertion. 

If when the ears are closed, we convey a watch into the cavity of the 
mouth without pressing it with the teeth, we do not hear the sound of its 
beat; while the noise will be distinctly heard, if we apply the teeth to the 
watch-case. This shews that it is not the eustachian tube which transmits 
the sound in this experiment. This is done by the teeth, which produce a 
perception of sounds by virtue of filaments from the second branch of the 
fifth pair of nerves which communicate with branches of the portio dura 
of the seventh pair. 

A long time before M. Perole, Verduc observed: "It is not merely because 
the air passes along the aqueduct, (eustachian tube,) that the deaf hear 
better; it is because, in seizing the handle of a musical instrument with 
the teeth, the thrill is promptly communicated to the jaw, to the temporal 
bones, and to the little bones of the ear. What favours this opinion is, 
that those who are not deaf, hear the sound of a lute better when they seize 
the handle of it with the teeth, and when at the same time the ears are 
closed. One can also make himself heard by the deaf, by speaking with 
the mouth in contact with the head, because by jarring the head the im- 
pression is communicated to the principal organ of hearing." (Traite de 
Physiologie, t. 11. p. 213.) 

M. Desjardinsj in his treatise on sounds, says that he has seen a deaf- 
14 



106 

another office, quite different from that which is assigned to it 
above. I have indicated it in the note to page 48, of the first 
section. 

The illustrious Morgagni treated of the diseases of the ear 
and examined minutely the structure of the mastoid apophysis. 
His researches, on this subject, instead of rendering him fa- 
vourable to the operation of which we have spoken, induced 
him to condemn it, as being a dangerous proceeding. This 
operation, indeed, often fails, in consequence of the peculiari- 
ties which are frequently met with in the structure of the 
mastoid apophysis. Morgagni and Hogstroem found septa in 
it, which prevented the communication of the cells < 

Another^circumstance which may render the perforation of 
the mastoid apophysis useless, is that the whole body of it is 
sometimes compact. M. Adolphus Murray, relates an in- 
stance, as follows. 

"There is sometimes a case, though rare, of which, however, 
I have instances in my cabinet, in which the mastoid apophysis 
is compact; so that, so far as we can ascertain, it is not possi- 
ble to find in it any cavity, or consequently, any communica- 
tion with the cavity of the drum."* 

Independently of these inconveniences, the application of 
the trepan upon the mastoid apophysis is attended with very 
great danger, to which the following occurrences may give 
rise, viz. hemorrhage, pain, spasms, convulsions and suffoca- 
tion. 

mute give signs of great fondness for music, by holding a key in hikteeth, 
the extremity of the key touching the instrument. The musician executed 
a very -melancholy adagio; mean-while the ' deaf-mute gave unequivocal 
signs of melancholy emotions. This piece was followed by a very lively 
allegretto, and the deaf-mute, all at once, began to smile -. "The sensation 
which he experienced" says M= Desjardins, "was owing to a trembling 
produced by each note." (There, sur les songes, Monsellier. ) 
* Journal dc Medicine, fev. 1793. 



107 

Tissot, in his life of Zimmerman, reports that the Baron de 
Berger, physician to the king of Denmark, died a victim to 
this operation. 

All these dangers did not dissuade Arnemann,* Professor of 
Medicine at Gottingen, from advising this operation. He re- 
duces the cases, in which the perforation of the mastoid apo- 
physis may be useful, to five. 

1st. When there is complete deafness, or when deafness 
pertinaciously increases. 

2d. When mucous fluids, which are secreted in the ear, re- 
main there and produce congestion, 

3d. When the ears are painful, and there is felt in them a 
continual ringing. 

4th. When the eustachian tube is obstructed by mucus, or 
other fluids which may be removed by injections. 

5th. Finally, when the cells of the mastoid apophysis con- 
tain purulent matter, and when they are carious. 

These cases are absolutely the same as those published in 
the Memoires de PAcademie de Suede, Nos. 3, 4 and 5, 
translated by M. Martin, former physician to the military hos- 
pital of Thionville. M. Arnemann has omitted only the case 
in which it is performed for the purpose of relaxing the mem- 
branes and the other soft parts of the drum of the ear, and 
giving pliancy to the small bones of the ear. 
* We proceed to examine the six varieties of disease, for 
which the operation under consideration is proposed. 

"1st. When there exists complete deafness, or deafness 
which gradually increases." 

What has there been stated above in regard to the causes of 
such a species of deafness, that an operation, which may be 
attended with such severe and even fatal results, should be 

* Bibliothique germanique, t. % 



108 

recommended with so little reflection? and that, for the 'pur- 
pose of accomplishing nothing more than can be done by 
means more simple, more mild, and by no means dangerous, 
such as injections into the interior of the ear, through the eus- 
tachian tube. If these, in consequence of some difficulty not 
often encountered, cannot be performed, it would then be 
better to practise the puncture of the membrana tympani, and 
inject the ear by the external meatus. The last method is in- 
comparably less dangerous than trepanning the mastoid apo- 
physis. 

"2d. When the mucous fluids, which are secreted in the 
interior of the ear, remain there and produce congestion." 

In the case supposed, I admit that injections thrown into the 
artificial opening, made in the mastoid apophysis, may effectu- 
ally remove the mucus accumulated in the cavity of the drum 
and mastoid cells, and even cleanse the eustachian tube; but, 
I cannot too often repeat it, to what pain and danger will he 
not expose his patient? It is in this case that the method of 
injecting the ear, which we shall propose, will be attended 
with complete success. 

"3d. When the ears are painful, and when a continual ring- 
ing is felt in them." 

In this case the remedy may be pronounced worse than the 
disease. However, if there was any hope of curing the pa- 
tient, there would be some propriety in proposing a severe 
remedy; but there is nothing more uncertain. In such a case, 
if, after the employment of general remedies, the pain and the 
ringing persist, proper injections, thrown into the ear through 
the eustachian tube, will be successful. I have given instances 
of their success. 

"4th. When the eustachian tube is obstructed by mucus, or 
other humours which may be removed by injections." 

It cannot be doubted that, in this case, as in the preceding, 



109 

injections by the eustachian tube are, in all respects, superior 
to the perforation of the mastoid process, and that they ought 
to be preferred. 

"5th. When it is necessary to relax the membranes and 
other soft parts of the drum of the ear, and give pliancy to the 
small bones of the ear." 

Here, again, is a case for the employment of emollient in- 
jections by the eustachian tube. 

"6th. Finally, when the cells of the mastoid apophysis con- 
tain a purulent fluid, and when they are carious." 

In the latter case, the perforation of the mastoid apophysis 
is infinitely less painful, and the danger is nothing, because na- 
ture accomplishes nearly the whole. The utility of the ope- 
ration also corresponds to its necessity, and it deserves to be 
preferred to all other remedies. The reasons why it is pre- 
ferable are so obvious that I think it useless to designate 
them. 



CHAPTER III. 

On dropsy of the tympanum and mastoid cells. 

Valsalva has often remarked, that in acute diseases there 
often occurs either some difficulty of hearing, or patients become 
quite deaf.* Sometimes these disorders survive the diseases 
which produce them. The same author discovered, in such 
cases, extravasations of water in the cavity of the drum and in 
the mastoid cells. This affection may supervene upon an in- 
ternal catarrh, or upon a blow or fall directly upon the ear. 

The signs which indicate this watery collection are almost 
identical with those which characterise a catarrhal affection. 

* There are but few practitioners who have not noticed the same thing, 



110 

Dropsy, like the latter affection, is accompanied with indis- 
tinctness of hearing, and with pain in the head. When the 
patient perceives a degree of tension, weight and a kind of 
roaring deep in the ear, it is not uncommon that the previous 
affections facilitate the diagnosis. It was thus that Valsalva 
discovered the formation of a serous congestion in the cavity 
of each typanum, at the conclusion of a fever. 

This disease is often spontaneously dissipated in conse- 
quence of the escape of drops of water, which are seen to 
flow from the nares or from the external auditory passages, 
when the head is lowered. The following case, which Dr. 
Perreymon, physician at Lorgues, department of the Var, pro- 
cured for me, is a proof of the fact. 

"Andre M # **, fifty-five years of age, of a lymphatic tem- 
perament and somewhat fleshy, suddenly, and without any 
known cause, became deaf in both ears. This deafness was 
accompanied with vertigo and pain in the head. There 
escaped from the two auditory passages, especially from the 
right, a limpid serosity which wet several large linen pledgets, 
and flowed for seven or eight days. At the end of this time, 
the deafness and other symptoms disappeared." 

This considerable quantity of serous fluid did not flow 
merely from the auditory passages; the cavity of the tympa- 
num and the mastoid cells furnished the greater part of it. 
The deafness and the symptoms which preceded the discharge, 
clearly prove it. 

If the serosity does not make its way through the pores of 
the membrane of the tympanum as in the preceding case, and 
the eustachian tube is obstructed or obliterated, the watery 
collection cannot be dissipated but by opening a passage for it. 

Three methods of accomplishing this object present them- 
selves: the puncture of the membrana tympani; perforation of 



Ill 

the mastoid apophysis; and injections, such as we shall pro= 
pose.* 

The latter method should be preferred to the two first; but 
should we not be able to remove the obstructions from the 
eustachian tube, a thing of rare occurrence, we ought to resort 
to the operation of puncturing the membrana tympani. As to 
the perforation of the mastoid apophysis, it should be rejected 
for reasons which I have alleged in the preceding paragraph. 

If the disease is not maintained by relaxation of the mucus 
membrane which lines the tympanum and the mastoid cells, 
or by the rupture of some lymphatic vessel, which the indi- 
cative circumstances preceding the dropsy may suggest, the 
simple evacuation of the water will be sufficient to cure the 
disease. But if, on the contrary, one of the causes named has 
given rise to the watery collection, we must have recourse to 
injections slightly tonic, as those of the mineral water of Ba- 
laruc and Bareges, with a few drops of ether, a decoction 
of cinchona carefully filtered, &c. &c. It will not be im- 
proper to maintain, for some time, a caustic issue or a seton 
in the neck. 

The treatment may be concluded by the use of mild purga- 
tives, given at considerable intervals, at least of five days. 

* The idea of evacuating a collection of water contained in the cavity of 
the drum by injections, seems, perhaps, paradoxical and erroneous, but it 
will cease to appear so if it be observed that when the water which is con- 
tained in that cavity cannot escape by its specific weight, it is because 
there is some obstacle present in the eustachian tube; such as mucus, ex- 
crementitious matters, or swelling of the pituitary membrane which lines 
the interior of the tube. The injections, by removing these obstructions, 
open a passage for the fluid contained in the drum. 



112 

CHAPTER IV. 

On extravasation of blood into the cavity of the tympanum and 
mastoid cells. 

Stenon and Morgagni state, that blood may accumulate in 
the cavity of the tympanum. Mr. Cooper reports an instance 
of it, accompanied with details which leave no doubt in re- 
gard to the existence of such a cause of deafness. We have 
quoted it, at length, at page 61 of the first section. 

From this fact it is obvious that a blow, or fall upon the 
head, may cause an effusion of blood into the cavity of the 
tympanum and mastoid cells. 

If, then, in consequence of these accidents, the patient 
bleeds from one or both ears, and becomes deaf, the deafness 
may depend upon the formation of clots in the external mea- 
tus; but if, after they are removed, the deafness continues with 
the same intensity, we shall have reason to believe that the 
immediate cause of the affection is extravasated blood, coagu- 
lated, perhaps, in the cavity of the tympanum and the mastoid 
cells. All doubt in regard to it will be removed, if, on inject- 
ing warm water into the interior of the ear, through the eusta- 
chian tube, the liquid issues bloody, or bringing with it small 
clots. 

The prognosis founded upon this cause of deafness is as 
easy to be ascertained as is the diagnosis. We may pro- 
nounce, with confidence, that the deafness which depends on 
a collection of blood, in the above named cavities, may be 
cured by the means which we shall point out. 

Treatment. I shall take it for granted that the means pro- 
per for preventing, or dispelling the symptoms of cerebral 
concussion, and the extravasation of blood in the cavity of 
the cranium, have been employed with success, and that there 



113 

remains nothing more to be attended to but the collection of 
blood in the cavity of the tympanum and mastoid cells. 

In the case mentioned above, Mr. Cooper perforated the 
membrane of the tympanum to give exit to the extravasated 
blood. He succeeded, because the blood was still fluid. But 
if it had become solid, the perforation alone would have been 
insufficient. It will be unnecessary, as I think, to enter into 
any explanation in regard to this. 

After having perforated the membrane, it will be necessary 
for the purpose of dissolving the coagula, to inject warm 
water into the ear, through the artificial opening. These in- 
jections effectually cleanse the tympanum and the tube. But 
if the extravasation extends even to the mastoid cells, the li- 
quid will not reach it. For this assertion, we have given rea- 
sons elsewhere. The blood stagnating in these cavities, irri- 
tates them and excites inflammation; hence will arise long- 
continued suppuration, abscesses behind the ear, caries, per- 
haps destruction of the organ, and consequently deafness. 

The mode of treatment by injecting the ear, which I pro- 
pose, is more simple, free from all inconvenience, is unattend- 
ed with any danger to the patient, and the cure will be more 
prompt and certain, because the injections will penetrate 
wherever the blood is extravasated. Warm water will suffice 
to relieve the organ of the blood which oppresses it, and will 
restore it to its natural condition. 



15 



114 



CHAPTER V 



On the accumulation of mucus and ceruminose matters in the 
cavity of the tympanum and the mastoid cells. 

Mucous, ceruminose, and even lymphatic fluids are suscepti- 
ble of being rendered thick and tenacious. This is a quality 
of their constitution, and of their chemical properties. It is 
not surprising, therefore, that their stagnation merely, in a warm 
situation, should tend to render them concrete, and thus to 
produce deafness. 

We know that, at an early period of life, mucus predomi- 
nates over all the other humours. Defluxions and catarrhal 
inflammations are particularly troublesome to infants. At so 
tender an age they are unable and know not how to expecto- 
rate; the mucus of the fauces, and of the nasal fossae, secret- 
ed in abundance, accumulates about and within the orifice of 
the eustachian tube and obstructs it; hence the stagnation of 
mucus in the cavity of the tympanum and the mastoid cells. 
The more fluid parts of these humours are again absorbed, and 
the more solid will concrete and cause deafness. 

This is the case, for the most part, with infant deaf-mutes, 
that are supposed to be deaf from birth, from fault of primary 
organization. 

These causes of deafness are very frequent, especially with 
infants of a lymphatic constitution, and who are often affected 
with herpetic eruptions on the head and face. 

The ancients were not ignorant of these causes of deafness, 
but they supposed that when, by lapse of time, this matter had 
become hard, it was impossible to soften or dissolve it, and 
hence that this variety of deafness was incurable. Surditas 
genita a crassis et pituitosis humoribus intemam auris partem oc- 
cupantibus immedicabilis est y si sit inveterata, Inveterata dicitur 
qim excessU duos annos; tarn longo enim tempore imbibilur in 






115 

Utis partibus humor, ita induruit] ut vix imo nunqumn possit, 
cmolliri et disculi, 

The mucous humour which accumulates in the cavity of the 
tympanum and the mastoid cells may exist there in different 
states: 1st, merely condensed; 2d, concrete or hardened. In 
the latter case, as well as in the former, the matter fills these 
cavities, but often it only over-spreads the internal surface. 
The ceruminose matter often occasions the latter condition. 

The symptoms, characteristic of these causes of deafness, 
are derived from the peculiar traits of those diseases which 
may have preceded them; such as stuffed nostrils, frequent de- 
fluxions, otalgia; the existence, or the mere vestiges of scabies 
or scrofula. If to these circumstances, there are added a se- 
rous or mucous discharge from the external auditory meatus; 
if, on blowing the nose, or on closing the mouth and nose and 
making a strong expiration, the air does not pass into the ear; 
or if an injection thrown into the eustachian tube encounters 
some firm obstacle, we shall be certain that the cavity of the 
tympanum is obstructed by mucus. If injections penetrate into 
this cavity as if it were unobstructed, and if the organ re- 
mains insensible, or almost so, to injections, we may presume, 
from these facts, that the concrete substance merely lines the 
cavity which we inject. This presumption will result in ab- 
solute conviction, if, after injecting for some days, we observe 
small bodies, of a yellow colour and friable consistence, to 
escape from the mouth and nose; also mucus covering the sur- 
face of the water which returns after the injection. We may 
regard this circumstance as a pathognomic sign of that parti- 
cular cause of deafness of which we are speaking. The fol- 
lowing facts substantiate the assertions advanced in this para- 
graph. 

Mile. G # * # de Sainte-Etienne, of the department of the 
Loire, aged 24 years, of a mucous habit, although of a florid 



116 

complexion, came with her mother to consult me, March 12th, 
1815. She had very considerable difficulty of hearing in both 
ears, with mucous obstructions of the external auditory passages. 
She could not be made to hear what was addressed to her in 
a loud tone and very near the ear, because mucous matters, much 
more dense, occupied at the same time the eustachian tubes, 
the cavities of the drum, and the mastoid cells. 

The presumed cause of the deafness was a suppression of 
perspiration, caused by attending a ball. 
• Injections of warm Balaruc water cleansed the auditory 
passages of the mucus which filled them, and of the white 
pellicles which lined them, but the hearing was not at all im- 
proved. 

Injections thrown into the eustachian tube could not at first 
be made to enter the cavity of the tympanum, although I 
pushed the piston of the syringe much more strongly than 
usual. The liquid regurgitated, in part, between the orifice 
of the hollow sound and the pipe of the syringe. It was not 
till after injecting for some days that a clot, of the form of 
the stem of a clove, escaped from the right eustachian tube, 
after my having injected it; afterwards, another clot, of the 
same form and size, was disengaged from the left. These 
clots were of a yellowish colour, and of a consistence much 
more firm than the sputa which sometimes escape, with pain, 
from the larynx or the trachea. Subsequent injections caused 
the escape, successively from the one and the other ear, of 
many other clots, of which the form and size varied exceed- 
ingly, but the colour and consistence were always the same. 

In proportion as this matter was detached, the injections 
penetrated into the interior of the ear with facility. The dif- 
ficulty of hearing slightly diminished, but in a much less de- 
gree than I had expected, because I was persuaded that the 
mucous concretions were the only impediments to hearing. 



117 

After the continuance of injections with the water of Bala- 
rue, for a month following, a blister to each arm, then another 
between the shoulders, and two purgatives after the healing 
of the last blister, the catarrhal humour had entirely disap- 
peared, without any remarkable change in the faculty of 
hearing. 

Ignorant of the circumstances which had preceded the deaf- 
ness, and which had been concealed from me, I had had, from 
the beginning, nothing in view but a catarrh which affected the 
whole interior of the organ of hearing except the labyrinth. I 
therefore predicted, prematurely, without doubt, that the young 
lady wtfuid be cured of her deafness. Her parents, with whom 
she lived during her residence in Lyons, at length told me that 
she had had, for six years, an attachment of a delicate nature. 
Her father disapproving of her choice, she suffered severe 
and deep affliction. It was at this time that her deafness 
commenced. The first affection was slight, but the infirmity 
progressively increased to the degree that Mile. G ## * was 
unable to hear, even when addressed in a high tone and near 
the ear. I could not, under these circumstances, mistake the 
influence of a nervous affection. 

With a view to attack this disorder, I prescribed whey, 
sweetened with the syrup of orange flowers, and qualified with 
a drachm of sulphuric ether to the pint; moderate exercise, a 
cooling regimen, injections of a decoction of bran and nitre. 
I employed injections of rose-water, qualified jrith musk, into 
the internal ear. All these means, however, effected no change, 
although they were continued for a month. 

A gland, of the size of a bean, situated near the course of 
the right jugular vein, and an unnatural thickness of the upper 
lip, led me to suppose that a scrophulous humour might have 
some concern in the deafness with which the young lady was 
affected. In consequence of this, I put the patient upon the 



118 

use of the syrup de Bellet, in the dose of a table-spoonful, 
morning and evening, given in a wine-glass of the decoction 
of bur-dock. This remedy was continued with care for a 
month, without her having derived any advantage from it. 

I should not omit to remark, that the ears were but little 
sensible to the injections, especially when I threw them into 
the external auditory meatus. 

Another particular worthy of remark, is, that this young 
lady hears sufficiently well, to this day, when she is addressed 
close to the ear; it is indispensable, however, that the mouth 
of the speaker should be placed in contact with the external 
meatus, otherwise she does not hear at all. 

Such is the condition of the young lady at present. Shall 
we pronounce her disease incurable? I think not. I believe, 
on the contrary, that a course of treatment, perseveringly di- 
rected against the nervous derangement which affects the ap- 
paratus of the internal ear, and especially a change of condi- 
tion favourable to the happiness of the young lady, would be 
productive of a happy result.* 

* We often observe that a depression of spirits, and the grief which 
springs from unhappy attachments, exercise an influence upon our senses, 
and produce either an exaltation or diminution of sensibility in the ner- 
vous system. Difficulty of hearing may readily arise from moral causes, 
the pathological phenomena being located in the acoustic nerves. M. Itard 
cites the case of a nun, who came to consult him for deafness. The first 
symptoms of the disease had occurred during a period of mental distress 
which this lady experienced, and they had been followed by deafness from 
the influence of the same causes, increasing or diminishing with the mental 
distress, to which the lady was a prey. M. Itard judged it proper to en- 
deavour to dispel the causes which gave rise to the affection. This being 
accomplished, he had recourse to the hollow sound, through which he di- 
rected the vapour of ether into the guttural meatus of the ear with the 
apparatus, a description of which will be found in this work. At the end 
of twenty days the hearing was sensibly improved. This treatment was 
continued some time, and was rendered more active by infusing the leaves 



119 

The son of M. Dcv. ### , nineteen years of age, had, from 
his infancy, very difficult hearing, and the disease constantly 
increased in its intensity. The right ear was affected with an 
extreme difficulty of hearing, and the left with complete deaf- 
ness. The young man could scarcely hear the beat of a 
watch, applied immediately upon the orifice of the latter ear. 
There had been protracted suppuration, pain, and buzzing 
noise in both ears. 

A tetter, occupying almost the whole scalp, was the sup- 
posed predisposing cause of the disease. 

Blisters and detergents had been employed, with steady per- 
severance, but without any success. 

On the 27th of September, 1814, 1 commenced a new mode 
of treatment. Injections were thrown into the eustachian tube 
more than a hundred times, but at different periods. The first 
period, in consequence of the severity of the season, was con- 
cluded on the 10th of November of the same year. The se- 
cond commenced on the 12th of March, 1815, and terminated 
on the 14th of June following; but at remote intervals there 
were interruptions of a few days. I injected each ear six, 
seven, and even ten times at a sitting. The water of Balaruc 
was the only liquid injected during the course of the treat- 
ment, either by the external meatus or by the eustachian tube. 

At the twenty-fifth sitting, the patient discharged from 
the right nostril, together with trie water injected into the 

of rue in the ether. At the end of a month, the benefit derived from the 
vapour baths of ether was so considerable, that the lady, who before could 
not hear except when she was spoken to in the ear very deliberately, and 
with a loud voice, conversed freely in an ordinary tone, only, however, by 
speaking near. 

M. Saissy might also have used, in this case, electricity, from which the 
best effects have been derived in similar cases; or what might be still 
better, tobacco smoke^ drawn in by the mouth and forced into the eusta- 
chian tubes Tlr p. 






1*0 

eustachian tube of the same side, a ceruminose concretion, of 
a reddish colour, of the breadth of a large bean, of the thickness 
of thin paper, and of friable consistence. At the twenty-sixth 
sitting a similar concretion escaped, in the same manner, from 
the left ear. M 

These concretions were followed by others of the same na- 
ture, but not so large. There afterwards escaped at different 
intervals, a substance of the colour and form of coarse tobac- 
co-scrapings. 

Hearing was re-established in proportion as the obstruction 
was removed. At this time the young man hears with the 
right ear as if he had never experienced any disease in that 
organ, while, with the left ear, he hears the beating of a watch 
at the distance of two feet. 

Finally, this young man who, before the treatment, could 
not enjoy the pleasure of conversation, in company, now takes 
part in it like any other individual. 

There remains in the external auditory meatus of the left 
ear, a puriform and very offensive discharge. It has resisted 
blisters applied to the arm of the same side, repeated purgatives, 
injections of the mineral water of Balaruc, the decoction of 
barley with honey, and decoction of cinchona. I did not wish to 
rely upon tonics, and I abstained from the employment of astrin- 
gents and discutients, fearing the repulsion of the humour upon 
the immediate seat of hearing, or upon some organ essential to 
life, a repulsion of which the records of our art furnish but 
too many instances. 



VL* * ft 

CHAPTER VI. 

On obstructions of the cavity of the tympanum and the mastoid 
cells j by calcareous substances. 

Arnemann* found, in the cavity of the tympanum, a substance 
resembling chalk. He supposed that those who had been 
affected with venereal diseases were the usual subjects of this 
affection. 

I knew a man, fifty years of age, who was very deaf from 
the time that he was fifteen years of age, in consequence of 
frequent attacks of the venereal disease. . I should observe 
that this individual never had chancre, or ulcer of the throat, 
or of the nose; so that the deafness could not be ascribed to 
closure of the opening of the eustachian tube. It is more 
probable that the disease was owing to an accumulation of a 
chalky matter, like that described by Arnemann, in the tympa- 
num and the eustachian tube. 

Hogstroemf saw a case of complete deafness resulting from 
venereal affections. 

Leschevin says, that "if, by any cause which may occur, 
the membrane which lines the mastoid cells, excretes a preter- 
natural quantity of mucus, as happens to the pituitary mem- 
brane in catarrh of the nares, it is certain that the cavity of 
j the tympanum would be overflowed, and that the membrana 
tympani, and the membranes of the foramina, rotundum and 
ovale, would be drenched and relaxed: a circumstance which 
would necessarily render hearing difficult. Besides, this fluid 
might, from some morbid peculiarity, become concrete. I 
doubt not, for instance, that the inspissation of it, caused by a 
venereal taint, and its retention in the cavity of the tympanum 



* Bibliotheque Germanique, t. ii, 

f Journal dc Med. chirurg, pharm. fev. 1793. 

16 



122 

and in the eustachian tube, may be one of the most frequent 
immediate causes of venereal deafness. It has been long since 
remarked, that the venereal virus has a particular affinity for 
the mucous fluids, such as those of the interior of the nose, of 
the throat, and of the palate. It is for this reason that these 
parts are so often affected with lues. The fluid of the mas- 
toid sinuses being of the same nature, it is not surprising that 
the venereal virus should readily blend itself with it."* 

Ambrose Pare thought that syphilis might be the cause of 
deafness. "We see," says that great man, "persons affected 
with the venereal disease, losing their hearing in consequence 
of severe pain in the head."f 

SennertJ reports, according to Platerus, that an Abbot, in 
consequence of venereal disease, became blind, deaf and dumb. 

It is, as I believe, sufficiently established that syphilis has a 
marked influence upon the lymphatic and mucous humours, 
which it tends to render thick and concrete. It is not surpris- 
ing, then, that this virus, being conveyed into the cavity of the 
tympanum and the mastoid cells, should coagulate the mucous 
fluid which moistens those cavities, and thus give origin to the 
cause of deafness with which we are occupied. But by what 
signs shall we be able to recognise this variety of deafness.?§ 

* Prix de l'Acad. royale de chirurg. t. iv. in 4to. 

f Ambrose Pare, liv. 19, p. 545. 

+ Sennert, cap. vii., p. 114 et 115. 

§We have here a specimen of the ancient humoral pathology which 
still, in some degree, prevails on the continent of Europe. The author 
evidently believes in the residence of specific poisons (humours,) in the 
circulating, and the secreted fluids. The reader will have frequeutly no- 
ticed that he speaks of the repulsion of these humours from parts upon 
which they may have fallen, and of this repulsion being a source of disease 
in some remote part on which the morbific humour may have been again 
precipitated. 

The venereal virus has no affinity whatever for the mucous fluids, but the 



12.3 

"If deafness," says Leschevin, "has been preceded by any 
venereal disorders, and more especially if it is accompanied 
by symptoms of lues, we shall have reason to believe that it 
arises from an accumulation of inspissated fluids in the drum."* 

A scurfy tetter upon the lobes of the ears, when it concurs 
with symptoms indicative of syphilis, affords strong' presump- 
tion that the deafness is owing' to a sediment deposited in the 
cavity of the tympanum and the mastoid cells, in consequence 
of that disease. 

According to Nisbet,f the deafness which is dependent on 
syphilis, is generally preceded, for many months, by a noise, 
or ringing in the ears. This ringing is accompanied with se- 
vere pains. When suppuration supervenes, or indeed without 
this, there is an ulcer slowly formed, which produces erosion 
of the organ. Often, also, this variety of deafness immediate- 
ly springs from an affection of die guttural orifice of the eusta- 
chian tube.J ■ 

morbid action of lues in some of its stages has a decided partiality for the 
mucous membranes. All the ramifications of this tissue may participate in 
the morbid changes. The mucous lining of the ear, as well as that of other 
organs, may become morbidly excited, thickened, and may secrete a mor- 
bid mucus, redundant in quantity and of a caseous consistence. 

The same remark is true in regard to gonorrhoea. All the mucous mem- 
branes may, in some degree, participate in the morbid condition of the 
lining membrane of the urethra affected with protracted gonorrhosa or with 
gleet. I have several times witnessed a degree of deafness from this 
source, and have now under treatment a case of this character. 

N. R. S. 

*Prix de l'Acad. royale de chirurg. t. iv. in 4to. 

f Traite des maladies veneriennes, p. 243. 

+ That variety of deafness arising from an old venereal taint, the pro- 
gress of which has not been arrested, and which does not proceed from ul- 
ceration obliterating the eustachian tube, most frequently arises from ca- 
ries of the mastoid portion of the temporal bone, the little -bones of the 
«ar, or some other osseous part concurring to form the structure of the in- 



124 

m 

A symptom which is common to obstruction of the cavity 
of the tympanum and the eustachian tube, whatever may be 
its cause, is that, on shutting the mouth and nose, and then 
making a strong expiration, the air is not felt entering the 
ears, nor striking upon the membrana tympani. 

Treatment. — We shall here consider merely the obstruction, 
whatsoever may be the causes which have produced it. We 
shall suppose that the previous diseases have been treated and 
that nothing more remains to be done but to remove their ef- 
fects. This will be accomplished by throwing injections into 
the ear in the manner which I shall hereafter describe. 

At first, these injections should be made with warm water, 
which should be continued until the cavities are free from the 
obstructing matter which fills them. This may be ascertained: 
1st, by the facility with which the liquid passess through the 
tube and into the cavity of the tympanum; 2d, by the fact that 
the patient perceives the liquid striking upon the membrana 
tympani; 3d, that he experiences a pleasant warmth in the in- 
terior of the ear, with a kind of tickling in the mastoid region. 

ternal ear; or more especially from the pus produced by this caries, and 
which is effused into the cavity of the tympanum; sometimes it arises from 
these two circumstances combined. 

Whatever it may be, the first indication to be answered, is to arrest the 
progress of the affection, by prescribing, without delay, a treatment suited 
to the nature and chronic character of the disease, not regarding the se- 
cond indication, which is to restore the hearing, till we have succeeded in 
neutralizing this source of mischief. 

A remedy, which in this case aids in fulfilling both indications, is the in- 
jection into the ear, through the eustachian tube, of a mixture of the li- 
quor of Van Swieten and a decoction of mallows or flaxseed, in proportions 
adapted to the condition of the subject. With these means we may arrest 
the progress of the caries by acting directly on the diseased part, and 
cleansing the cavities of the internal ear, where the effusion has taken 
place. Th. P. 



125 

These are the signs which indicate that the obstruction no lon- 
ger exists. 

When this is accomplished the patient hears acutely; but 
if there still remains a degree of confusion in the perception of 
sounds, caused by engorgement of the part, there should be 
added to the warm water a few drops, either of the tincture of 
musk, sulphuric ether, lavender water, or Hungary water, but 
the mineral water of Balaruc or Barege will be attended with 
more remarkable and prompt effects. We have reported an 
instance which was furnished us in the case of Berthon D. # 

Perforation of the mastoid apophysis,f electricity J and gal- 
vanism^ have been recommended for the cure of that variety 
of deafness with which we are now occupied. 

We have given our opinion in relation to the first of these 
means. We shall show, below, the inutility and danger of the 
two latter. 



CHAPTER VII. 

On the diseases which affect the small bones of the ear. 

The small bones of the ear are subject to defects of prima- 
ry organization, to caries, and to anchylosis. 

M. Lebouvier-Desmortiers, on having carefully opened the 
cavity of the tympanum in a calf, for the purpose of observing 
the small bones of the ear in their relative position, found the 
incus articulated with the head of the malleus in the natural 

* See chap. ii. of this section. 

f Arneman, Biblioth. Germanique t. 11. 

I Berthelon on the electricity of the human body, t. 1. p. 502 and the 
following. — Manduit, mem. of the Royal Society of Med. — Lebouviar Des- 
mortiers, considerations on congenital deaf-mutes. 

§ Grapengiesser, Biblioth. girm. t. viii. 



126 



position, but the handle of the malleus was entirely absent. 
"Thus," M. Lebouvier says, (supposing that the handle of the 
malleus was naturally absent,) "the calf to which this ear be- 
longed was born deaf, and would have continued so, during its 
whole life. Any person who might have the same defect, 
or any other equivalent to it, would be deaf and dumb."* 

It is to be desired that the author of this anatomico-patholo- 
gic observation had stated whether this imperfection existed 
in both ears or only in one; for if the defect of organization 
existed but in one ear, the animal would not have been de- 
prived of hearing, and a person who should be in the same 
condition would neither be deaf nor dumb. 

But is it perfectly certain that merely this defect of organi- 
zation would be sufficient to destroy the function of the organ 
of hearing? To me it appears doubtful. The observations 
of Riolan, Cooper, &c. &c. in regard to the partial and com- 
plete destruction of the membrana tympani, induce me to 
believe, that the defect of the handle of the malleus is not, 
and cannot be, a cause of deafness, especially of complete 
deafness; for when the membrane is destroyed, the attach- 
ment of the malleus also is, and hence the bone becomes 
useless in regard to the perception of sounds; nevertheless, 
individuals still preserve, at least in part, the faculty of hearing. 

The little bones in question are sometimes affected with 
anchylosis, Ruyschf says that he has seen, in the body of a 
new-born infant, these bones irregularly joined together con- 
trary to their natural order. 

The illustrious J. Louis Petit cites an instance from his own 
experience, in the first volume of his posthumous works. 

Valsalva found the stapes grown to the foramen ovale 

* Lebouvier-Desmortiers, considerations upon deafness, &c. 
fPalfin, anatomic chirurgicale, t. i. p. 430. 



127 

(Tractatus de aure humana, chap, ii, sec. 10,) and Reimaner 
found the bones of the ear wholly wanting. 

Baillie has, in three instances, seen the small bones of the 
ear smaller than natural. 

M. Richerand says "The destruction of the small bones of 
the ear produces deafness by opening the foramen ovale. 
The liquor of Cotunnus, which fills the cavities of the laby- 
rinth, flows out and deprives the auditory nerves of the 
liquid necessary, both for the purpose of preserving them in 
the moist and supple state requisite for the perception of 
sounds and for transmitting the vibrations of the air."* 

It is impossible, as I believe, to distinguish whether the 
deafness is owing to anchylosis of the small bones, or to some 
other disorder of these parts. 

It is obvious, however, that the species of deafness which 
proceeds from either of these causes is incurable by any known 
means.. Although we might cure the caries by means of de- 
tergent injections, the deafness would remain. 



CHAPTER VIII. 

On diseases which may affect the muscles attached to the small 
bones of the ear. 

Palsy and rupture are the most frequent affections of the 
muscles under consideration. 

There are many causes which may give rise to palsy, but 
the most frequent are adynamic and ataxic fevers, also rheu- 
matic affections. Among the cases which I have accumu- 
lated in relation to this subject I will confine myself to the fol- 
lowing. 

*No&ographie chirurgicale, t. ii, p. 135. 



128 

Josephine P* ## , 36 years of age, of the department of 
Jura, suffered in 1811, an adynamic fever, which rendered 
her very deaf. The deafness was accompanied with a very 
troublesome buzzing, and with considerable pains in the head. 

A seton in the neck, a caustic issue on the left arm, and 
many other remedies applied to the ears, and introduced into 
the aditory passages, were attended with no satisfactory result. 

On the 14th of April, I commenced the treatment, by throw- 
ing injections into the eustachian tube through the nasal passa- 
ges. These injections were composed successively of warm 
water, to which I added a few drops of lavender water, then 
of ether, tincture of musk, and finally the mineral water of 
Balaruc. 

I continued this treatment for two months and a half, at the 
end of which time, the buzzing sound, and the pains in the 
head had ceased; but hearing was but little improved. Six 
months afterwards, Josephine P*** wrote me that she heard 
very well, and that her hearing every day became better. 
Finally, at the commencement of the present year, 1817, she 
came to see me and declared that she heard as well as she had 
done before the disease which had caused the deafness. 

The following case bears some analogy to the preceding: 

M. Malibran, surgeon to Saint-Rambert-P Ile-Barbe, sixty- 
two years of age, was affected with a difficulty of hearing in 
both ears, with a considerable degree of the buzzing noise. 
This infirmity every day increased. The advanced age of 
the patient had nothing to do with the disease, a rheumatic 
affection being the cause of it. 

The buzzing sounds were strong and constant. The patient 
was so deaf that he could hear only when he was addressed in 
a loud voice, and very near the ear. 

On the 25th of June, 1816, I commenced the treatment, 
(which consisted merely of injections of the mineral water of 



129 

Balaruc, thrown into the interior of the ear, through the eusta- 
chian tube.) I continued it till August 3d, of the same year. 
After the sixth sitting, the buzzing noises diminished, and they 
were entirely dissipated by the continuance of the injections. 
Nevertheless the hearing had gained but little when we dis- 
continued the treatment, but a short time after M. Malibran 
remarked that it was more perfect, and that it gained strength 
every day, although the season was rigorous, and although, 
on account of his peculiar situation, he was obliged to expose 
himself to all the inclemency of the weather. Finally, the pa- 
tient hears at this time as well as any individual of the same 
age, who has experienced no defect in the organ of hearing. 

These facts tend to prove that in most cases, although the 
deafness may but very slowly yield, during the course of the 
treatment, hearing may finally be re-established, if the buzzing 
noise in the organ has ceased or nearly so, by the influence of 
the above treatment. 

The last case also proves that deafness may be treated with 
success, at any period of life, when the cause of it is accidental. 



CHAPTER IX. 

On tlie buzzing, (bourdonnenient) or roaring noise which affects 

the ears. 

This disease consists in the perception of sounds which do 
not really exist, or, at least, which do not exist exteriorly. 

The different kinds of buzzing noise are distinguished by 
the nature of the sounds which the patient hears, or thinks he 
hears, and the causes which give rise to the disease. 

The morbid perception is called roaring (bombement) when 
the sound heard is grave; ringing, (tintement) or hissing, if it 
be acute. 
1 17 



30 



From these peculiarities, authors have derived the same 
number of distinct forms of disease, although, in reality, they 
are merely so many varieties of the same disease- "so nearly 
the same, says M. Itard, that we often observe them to occur 
successively, in the same individual, and to be exchanged, 
irregularly, the one for the other, in a short space of time."* 

When the sounds have a real existence, which results from 
the physico-vital laws, the disease is designated under the 
name of true buzzing (bourdonnement vrai.) 

If on the contrary, the buzzing cannot be accounted for on 
the principles of acoustics, it is termed false. 

Each variety of the buzzing noise has its peculiar causes. 
The true buzzing arises from various causes, which may be 
referred, according to Itard, to two general ones, the circula- 
tion of the blood, and agitation of the air. 

1st. The blood circulating in the ear, or its vicinity, may 
produce the true buzzing by the aneurismal dilatation of some 
vessel, and then the noise which is heard is synchronous with 
the pulsations of the heart. It never diminishes — has no in- 
termission, and sometimes becomes so intense that it may even 
be perceived by the attendant. Duverney cites a very curious 
fact in relation to this subject. 

"I have witnessed," says that author, u the case of a lady 
of Picardy who perceives, on the least violent exercise, a 
pulsation in the ear so troublesome, that it appears as if she 
had a pendulum attached to her head. This pulsation is also 
heard by those who approach her. The beating is nothing 
more than that of a dilated artery, because it always accords 
perfectly with the pulsation of Ihe heart"! 

Plater and Mercurialis have observed the same phenomena. 
I have had occasion to see two persons in whom the buzzing, 

* Dictiormaire des Sciences uudicales, t. iii. 

J Duverney, Traite, des Povgane rte l'ou'ie, p 166 



. 



131 

with which they were afflicted, was owing to this cause. 
But in these subjects it did not exist in the same degree of 
intensity, as in those of whom mention is made by the authors 
quoted above. 

2d. The true buzzing may also arise from the increased 
impulse of the blood in the arteries of the head, as occurs in 
violent fevers, or in a paroxysm of anger; but the morbid 
sensation which is merely the effect of the fever, or the fit of 
anger, ceases together with the cause. 

3d. A state of permanent plethora, or an accidental reple- 
tion of the blood vessels of the head also gives rise to the 
buzzing sound. 

4th. The immoderate use of spirituous liquors, by causing 
a determination of blood to the head, gives rise, not to a 
buzzing, but to a kind of hissing sound. 

5th. The air w r hich passes through and fills the passages 
and cavities of the ear, if it be driven about, or if it be con- 
fined in an unaccustomed manner, becomes, in the interior of 
the organ, a cause of the buzzing sensation. 

6th. Mucosities, which partially close the orifice of the 
eustachian tube, and tumours which compress it, produce the 
same phenomena. 

7th. Diseases of the auditory nerve, when they are not 
very intense, also produce the buzzing noise in the ear. I 
give instances of it in the sixth section. 

The false buzzing most commonly attacks persons whose 
ears are very sensitive. It is generally produced by very long 
continued and violent sounds, such as the sound of bells, the 
firing of large pieces of artillery; u or especially," says M. 
Itard, "when the sounds, although not violent, yet, from pe- 
culiar accompanying circumstances, have left a strong impres- 
sion upon the mind."* 

*Dictionnaires des Sciences medicates, t. iii. 






The buzzing which arises from such causes is idiopathic. 
It is symptomatic when it depends; 1 st, on nervous diseases such 
as hysteria, hypocondria, convulsions, mental alienation; 2d, 
when upon gastric derangements, nervous and bilious en- 
gorgement; 3d, upon cachexy, produced by copious he- 
morrhages. 

By what symptoms shall we distinguish these various kinds 
of morbid sensation in the ear? It appears to me that, by the 
aid of the following data, we may so characterize them that 
one need not be confounded with the other, for example: — 1st, 
if the buzzing come on by degrees and without manifest 
cause; 2d, if it depend upon cerebral plethora (which is 
known by the heaviness of the head and suffusion of the face) 
the vessels of that part and of the temples being engorged; 
3d, if it be the result of some disease of the ear or of the 
eustachian tube; 4th, if an adynamic or ataxic fever has given 
rise to it, we may be sure that the buzzing is true. But the 
buzzing sometimes causes, and is still more frequently a symp- 
tom of deafness; in regard to this it is important that we 
should discriminate. 

M. Itard appears to me to have very well distinguished the 
idiopathic buzzing from the symptomatic. "These," says he, 
"are the symptoms by which I recognise its idiopathic cha- 
racter. The deafness diminishes and augments with it; if 
there is any intermission hearing is at the same time restored. 
Deafness which is caused by the buzzing presents this pe- 
culiarity also, that it does not disturb, at least at the com- 
mencement, the perception of sounds or noises, however feeble 
or distant they may be, but merely destroys the perception of 
a word, or sound, uttered at the same time with others, they 
being in some way blended and confused, as in general con- 
versation, or as in a song with accompaniments." 

The symptoms which characterize the false buzzing are 



133 

derived from the causes which produce it, and of these causes 
there are two varieties, the idiopathic, and the symptomatic 
1st. When the buzzing attacks very nervous persons, no other 
cause having concurred. 2d. When it occurs after having 
been preceded by loud and long-continued noises, such as the 
ringing of bells, or the firing of artillery. 3d. When it is the 
result of a fright, occasioned by some extraordinary noise, 
although not very loud, like that which wakes, in alarm, the 
mother of an infant, whose couch has become the prey of the 
flames,* — the false buzzing which one of these causes may 
have produced, is the idiopathic. 

But it is symptomatic when* it proceeds from hysteria, hy- 
pocondria, mania, convulsions, from worms in the stomach 
and intestines, or when it results from copious hemorrhages or 
from strong emotions of the mind, &c. 

Treatment. — We should never lose sight of the causes of 
this affection, of whatsoever variety it may be. If the mor- 
bid sensation be that which we have termed true, and if it 
depend on general plethora, bleeding from the arm or foot, 
repeated according to circumstances; pedeluvia morning and 
evening; cooling and emollient injections; refringent drinks, 
such as chicken water, or whey qualified with nitre, and a 
vegetable diet, will remove the cause of the buzzing. 

When the buzzing is owing to local plethora, we should 
open the jugular vein, or we should apply leeches to the neck 
and temples; then, recourse should be had to cold lotions ap- 
plied to the head and neck, such as cold water and ice. 

There are only palliative remedies, when the dilatation of 
an artery is the cause of the buzzing: 1 st, all violent exercise, 
such as riding on horse-back, and running on foot; 2d, singing, 
public speaking, playing upon wind instruments; 3d, the use 

* Ouvrage citfc. 



134 

of spirituous liquors — in a word, every thing which may ac- 
celerate the circulation of the blood in the vessels of the head 
must be interdicted. 

When the disease depends upon some obstruction in the ca- 
nal of the eustachian tube, or in the cavity of the tympanum, 
injections thrown into the tube, by diluting and washing away 
the deposition, remove the obstruction and dispel the buzzing 
sound. 

At the termination of an adynamic or ataxic fever, or a ca- 
tarrh of the internal ear, there often remains a buzzing more 
or less considerable. Warm lavements of the mineral water 
of Balaruc, Bareges, or of Aix* in Savoy, or water qualified 
with ether, thrown into the interior of the ear in the form of 
an injection, will be attended with very good success. I have 
cited many instances of it in the second section. 

In the false buzzing, of which the cause is a nervous disease, 
such as hysteria, or hypocondria, "it is necessary," says M. 
Itard, "to have recourse to general remedies, and to make the 
cure of this affection dependent upon that of the nervous affec- 
tion. The same treatment is proper in cases in which we re- 
cognise as a cause any gastric derangement, or general debili- 
ty from loss of blood, or from the effect of a scorbutic cac- 
hexy."* 

But it must be confessed that in a great many instances the 
morbid perception persists and increases without our being 
able to ascertain the cause or the true indication. Under 
such circumstances, a great many remedies have been tried, 
almost always without success, such as the smoke of tobacco, 
forced into the ear, or inhaled by the mouth, and propelled 
into the eustachian tubes, also the infusion of dried trefoil em- 
ployed in the same manner. 

* Ouvrage cite. 



SECTION III. 

ON THE DISEASES OF THE EUSTACHIAN TUBE, 

These channels are essential constituent parts of the organ 
of hearing. They cannot be affected with disease or even 
compressed by swelling, or by an excrescence of the neigh- 
bouring parts, without materially influencing the function of 
hearing. 

I shall divide the affections of the eustachian tube: 

1st. Into those which directly affect this tube, such as an 
imperforate state of the expanded orifice of the tube, obstruc- 
tion or obliteration of the canal, and catarrhal engorgement of 
the same part. 

2d. Those diseases which affect the eustachian tube not so 
immediately, but which nevertheless give rise to deafness, and 
often to serious diseases of the internal ear, will be the subject 
of the second part. 



CHAPTER I. 

On the imperforate condition of the eustachian tube, and the 
closure of that canal. 

Infants are sometimes born with the canal of the urethra 
imperforate, others with imperforate anUs, some with imperfo- 
rate vagina and os uteri. In the same manner also, there are 
those who are born with the eustachian tubes imperforate. In 
the latter case the subjects of the mal-formation are deaf-and- 
dumb. 

Another kind of closure of these tubes which is very fre- 



136 

quent, is that which results from inflammation of the throat T 
as in scarlet fever. I know two persons in this condition, one 
aged forty years, completely deaf in the left ear ever since the 
age of nine; the other aged twenty-seven years, completely 
deaf in both ears, in consequence of the same disease, which 
she experienced at the age of three years. 

The small-pox sometimes gives origin to this disease; an in- 
stance of it is to be seen in the Ephemerides des Curieux de 
la Nature. A young woman, in consequence of small-pox, 
had an ulcer of the uvula, and afterward an ill-conditioned 
ulcer of the nose, which attacked the openings of the eusta- 
chian tubes and effected the closure of those canals. 

"It often happens," says Cooper, "that the cicatrization of 
venereal ulcers of the throat closes the passage of the eusta- 
chian tube, and destroys the faculty of hearing on the side af- 
fected." 

"I have seen," says Swediaur, "many instances of deafness 
and of violent pains in the ears, produced by venereal ulcers 
which affect the orifice of the eustachian tube."* 

If, on shutting the mouth and nose,f and then making a 
strong expiration, the patient does not perceive the air passing 
into the tubes, or striking upon the membrana tympani, we 
may conclude that the tubes are closed. This symptom is 
common to the congenital imperforate condition, that which 
is owing to some disease of the throat and the nasal fossae, 
and the complete obstruction of these tubes. 

We may also ascertain the closure of these canals by prob- 
ing through the nasal passages. If the orifice of the porch of 

* Traite des maladies veneriennes. 

f The same author met with a case of complete deafness which was the 
result of gonorrhcea suppressed by the internal use of turpentine. The pa- 
tient had no chancre, nor any venereal affection of the nose nor of the 
fauces. 



137 

the tube is not found, it is a proof that the obstruction is locat- 
ed upon the orifice; but often the septum, or cicatrix which 
intercepts the passage of air, is more deeply placed, and then 
it forms a species of cul-de-sac, in which the beak of the sound 
is engaged and an insuperable resistance is experienced. If to 
this resistance there is added an elasticity and a slight pain in 
the part which is touched, then there is no doubt that a mem- 
branous septum is the obstacle which prevents the ingress of 
air into the cavity of the tympanum. If we attempt to pass 
an injection, a resistance is experienced, and besides, nothing 
passes into the interior of the ear. 

I have met with a case perfectly similar in the person of M. 
D. of A. The left eustachian tube is closed even with the 
porch of the tube, so that in the right side there is a cul-de- 
sac about a line and a half in depth. 

In the cases which we have stated, hearing may be restored 
if the obstacle to the perception of sounds belong merely to 
the porch (pavilion) of the tube, or to but a small portion of 
the tube, provided, nevertheless, that the immediate organ of 
hearing is not too much concerned; for then the faculty of 
hearing is irrecoverably lost. 

Treatment. — Two modes of treatment present themselves; 
puncture of the membrana tympani, and perforation of the 
membranous septum which closes the eustachian tube. 

As to the perforation of the mastoid apophysis, I think that 
it ought to be rejected as uncertain and dangerous. 

Three circumstances in the form of disease under considera- 
tion demand the perforation of the membrana tympani: — 1st, 
when the septum which closes the tube is placed on a level 
with the margin of the orifice of the tube; 2d, when the eusta- 
chian tube is obliterated throughout its whole extent; 3d, when 
the membrana tympani is ossified, and when at the same time, 
the other parts of the organ are in a natural state. The ope- 
18 



138 

ration should be performed in the manner described in the first 
section. 

The other operation has for its object the restoring of the 
eustachian tube to its natural state. To perform this it is ne- 
cessary to have a silver stylet, one of the extremities of which 
is armed with a steel point, like that of a trochar; the other 
should be made small as is the shaft of the instrument, that it 
may enter the hallow canula which serves to probe or sound 
the tube. It is then introduced into the beak of the hollow 
instrument, (algalie) and the blunt extremity is pushed beyond 
the external orifice, so that the point of the trochar may be 
concealed at the beak. The canula being thus armed, is in- 
troduced into the nasal fossae as in injecting the tube. When 
it encounters the obstacle, which is known by the resistance, 
by the depth to which the sound has passed, and by the direc- 
tion of the shaft, which is at the external extremity of the ca- 
nula, the stylet is to be gently pushed forward till the cessa- 
tion of resistance announces that the obstacle is overcome. 
Then the stylet is to be withdrawn, by making the trochar re- 
enter the canula, which serves as a sheath for it. The latter 
is then removed by employing, inversely, the manipulation by 
which it was introduced. 

The opening which is thus made would soon close again 
were it left to itself, therefore there should be a tent introduc- 
ed just beyond the point at which the obstruction existed, 
and it should be suffered to remain there twenty-four hours. 
This should be followed by another, and this last by a third 
and so on, until we may presume that the walls of the eusta- 
chian tube are cicatrized. 

For this purpose we substitute a piece of cat-gut for the 
stylet. This is introduced into the canula as far as the beaded 
extremity, beyond which it ought not to protrude. A mark is 
made with ink upon the cat-gut, just on the outside of the ex- 



139 

ternal orifice of the canula, to the extent that the tent is de- 
signed to pass heyond the obstacle. 

The canula thus armed, is again to be introduced into the 
eustachian tube as far as where the obstruction existed. The 
cat-gut being then pushed forward as far as it is marked, the 
canula is withdrawn and the tent left. In leaving the cat-gut 
in its place, it is necessary to hold it firmly at the distance of 
an inch from the external orifice of the canula, while the latter 
instrument is withdrawn, by repeating inversely the manipula- 
tions by which it was introduced. When the instrument has 
been passed along that part of the cat-gut which is between 
the fingers and the opening of the canula, the retraction of it 
is to be stopped, the fingers which grasp the cat-gut must be 
removed, that the instrument may pass along another portion 
of it, care being always taken to hold securely the piece of cat- 
gut. The instrument being removed from the nasal meatus, 
the tent should be cut off near the nose, and fixed in its place 
by gently stuffing the nostril with cotton or lint. 

This operation, complicated in description, is much more 
simple and easy in execution.* 

* The process which the ingenious Ducamp has employed in the treat- 
ment of strictures of the urethra, would here be very useful. The em- 
ployment of caustic is less to be feared, in this case, than that of a sharp 
instrument. 

It acts, it is true, in a slower manner, but much more certainly. A canula 
armed with a trochar, introduced thus deeply, may take a wrong direction, 
inflict injury upon nerves and thus give rise to alarming symptoms, wound 
the branch of an artery, and give rise to a hemorrhage which might defeat 
the success of the operation. Besides, the other method is less painful, and 
in performing it, it is unnecessary to introduce the tent of cat-gut, designed 
to prevent the closing of the lips of the wound, a mode of dressing difficult 
for the surgeon as well as distressing and troublesome to the patient. 

As in this case there is no stricture to be overcome, but only an imperfo- 
rate state of the eustachian tube to be remedied, it is necessary to modify 

f M 



140 

^he method which I recommend has the advantage of re- 
storing* the function of the organ, without inflicting any injury 
upon it. It is practicable whenever there is a cul-de-sac in 
the porch of the tube, although not more than a line in depth, 
but it cannot be employed when the orifice of the tube is 
closed even with the margin of the original opening, because 
then it is impossible to fix the instrument, or to ascertain accu- 
rately the place where it ought to penetrate. 

This method is equally impracticable when the tube is ob- 
literated throughout its whole extent. It is to be presumed 
that such is the extent of the obliteration when, after passing 
the stylet four or five lines, the same resistance continues to be 
felt. 

The operation which I have just described, I tried in July, 
1813, on the person of M. D. of A., of whom I spoke in sec. 
ii. chap. 2d. 

After having taken into account the circumstances which 
had preceded and followed the deafness, I examined, though 
not very carefully, the external auditory passages. As there 
were numerous little hairs dispersed over the part, which pre- 
vented my seeing the bottom of the passage, I carried my in- 
vestigations externally no further. 

I then directed my attention to the eustachian tubes. By 
exploring these parts, I discovered that the left tube was closed 
even with the orifice of the cartilage, so that it was impossible 
to fix the sound, or to determine the precise point into which 

the instrument in some respects. Instead of placing the caustic in the sides 
of the fossae in the metallic portion, as in the instrument of Ducamp, it is 
necessary to have a socket hollowed out in the extremity for the nitrate of 
silver, which should here be employed, not for the purpose of removing a 
lateral stricture, but rather for restoring a channel which has been com- 
pletely obstructed. 



141 

the trochar ought to be plunged, I therefore discontinued all 
further attempts upon that side. 

On the right side, however, the opening of the tube pre- 
vented an excavation, or cup, about a line in depth. The 
sound entered the fossa and was easily fixed there. 

After this discovery I had no longer any doubt in regard to 
the cause of the deafness. Consequently I determined to per- 
form, on the right eustachian tube, the operation which I have 
described. I plunged the stylet to the depth of four lines, 
without perceiving that it passed the obstacle. I withdrew 
the stylet and inserted a piece of cat-gut. The next day I 
made a second attempt, passing the stylet two lines deeper, 
but without any success. Nevertheless the operation was not 
painful or followed by any unpleasant symptom. 

This attempt wholly ineffectual as it was, will not, I trust, 
be useless to our science. It establishes: 1 st, the practicabili- 
ty of the operation which I have described; 2d, that it is but 
little painful; 3d, that we may penetrate with the instrument in 
the direction of the closed eustachian tube, to the extent of six 
or eight lines, without fear of any dangerous occurrence. 

Despairing of being able to restore hearing by this process, 
I took into consideration Mr. Cooper's operation. In order to 
ascertain the condition of the membrane, I introduced a blunt 
stylet into the external meatus. The depth to which the in- 
strument entered, and the sound produced by its striking the 
part with which it came in contact, convinced me that I had 
entered the cavity of the tympanum, and that the membrana 
tympani was destroyed. The left ear was in the same state. 

I believe that I am the first individual who has described or 
practised the operation of which I have just spoken. Before 
attempting it I had made many experiments upon the dead body 
in the following manner: After having first pierced the mem- 
brana tympani, I inserted in the eustachian tube a little cone 



142 

of wax, excavated and open at the top. The base was closed 
and turned toward the internal opening of the eustachian tube. 
Necessarily, then, the cone would mould itself to the tube and 
it would be so deeply buried as to make, at the internal open- 
ing, a cul-de-sac, a line and a half in depth. The body being 
conveniently placed I perfomed the operation described above. 
The absence of resistance indicated to me that I had entered 
the cavity of the cone. To assure myself more positively, af- 
ter I had withdrawn the canula, I removed the stylet, and again 
introduced the canula by the nose. This having entered into 
the cup, I threw in an injection which issued by the external 
meatus. 



CHAPTER II. 

On catarrh of the eustachian tube. 

This disease is of the same character as that which affects 
the cavity of the tympanum and mastoid cells. It is rare, 
when the latter parts are affected with the catarrhal inflamma- 
tion, that the eustachian tube and its expansion are not con- 
cerned. 

The causes and the symptoms being the same as those of 
catarrh of the tympanum and cells, the treatment should also 
be similar, we therefore refer to chap. 1st. sec. ii. 



CHAPTER III. 

On obstructions of the eustachian tube. 

This passage may be filled with blood, with mucus, or with 
a substance resembling chalk. Among the causes which pro- 
duce obstruction of the expansion and canal of the tube, I enu- 



143 

merate the swelling of the pituitary membrane which lines 
these cavities, provided, nevertheless, that the sides of those 
parts be not adherent, for then there exists not a mere obstruc- 
tion, but a complete obliteration, which it is important not to 
confound with the former. 

1 st. On mucous obstructions. — Guyot,* maitre des postes de 
Versailles, was seized with deafness caused by mucus which 
obstructed the eustachian tube. 

Herhaldt, surgeon in Copenhagen, was convinced by ana- 
tomical investigations made upon dead-born animals, that the 
eustachian tube, when the foetus is still contained in the uterus, 
is filled with the liquor amnii and with mucus, "so that (as say 
the editors of the Bibliotheque Germanique,) there is established 
an equilibrium between the exterior fluids and those within, 
without which the membrana tympani would suffer a violent 
compression from the water in which the foetus floats."f 

Whatsoever may be the rationale of the translators, the 
observation of Herhaldt is important, and it throws light upon 
a cause of congenital deafness which is much more frequent 
than is supposed. 

However, Herhaldt is not the first who developed this fact. 
It is now more than thirty-three years since I heard the 
celebrated Dessault, in his lectures on Anatomy, remark that 
the foetus in utero had the cavities of the mouth, oesophagas, 
stomach and intestines, larynx, trachea arteria, the nostrils, the 
eustachian tube and the external auditory conduits filled with 
the liquor amnii. That great man did not merely assert 
the fact; he demonstrated it, when he treated of the ana- 
tomical peculiarities of the foetus before it had breathed. 

Jonathan Wathen, surgeon, of the city of London, found 

* Mem. de l'Acad. Royale des Sciences, arm. 1724. 
t Bibliotheque Germanique, t. 1, p. 327. 



144 

in the body of a man, who had been rendered deaf by cold, 
the eustachian tube obstructed by concrete mucus* The 
authors of the Leipsick Commentaries report the fact in the 
following words: Repererat autor in cadavere viri quern frigus 
auditu privavcrat, tubam eustachianam congelati mud plenam.^f 

Tinka reports the same fact in a manner somewhat different, 
more at length, and with more appearance of correctness. 
The following is his account of it. Wathen refert historiam 
viri xxxv annorum utraque surd% cui rei occasionem refrigeratio 
corporis dedit, nee varia per plures annos adhibita malum tollere 
quiverunt, donee tandem homo ex variolis decessit. A morte 
nihil uspiam in organis est repertum, prceterquam in solis 
tubis, quas mucus densatus ex toto opplebat. (Historia cophosis; 
Vindobonai) 1778.) 

2d. A substance resembling chalk sometimes obstructs the 
eustachian tube, as well as the cavity of the tympanum and 
the mastoid cells. Arnemann has seen an instance of it which 
I have cited. My own practice also furnishes an instance of 
it in the person of Berthon D. of whom I spoke in the second 
chapter of the second section. 

3d. Hemorrhage from blows, or falls on the head may 
produce an extravasation of blood in the internal ear, which 
coagulating may obstruct the eustachian tube, the cavity of 
the tympanum, and the mastoid cells. Such is the opinion of 
Stenon and Morgagni. Cooper relates an instance of it ac- 
companied with particulars which leave no doubt in regard to 
the existence of such a cause of deafness. 

4th. The tumefaction of the pituitary membrane which 
lines the orifice of the tube and also the interior of that 

* Undoubtedly the subject of this case died soon after having suffered the 
chill. 

t Comment. Lepsise anno., 1749. 



145 

canal, caused by frequent and protracted defiuxions, gives rise 
to a transient deafness which often becomes permanent in 
infants of an early age. This cause of deafness is in young 
subjects more common than is generally believed. The fol- 
lowing case proves that persons of a more advanced age may 
be the subjects of this affection, which may produce in them 
a greater or less degree of deafness, together with a disa- 
greeable swelling of the parts. 

An indurated swelling of the tube, which may be produced 
by a venereal taint, or other cause, may produce the same 
result. 

Diemerbroeck, for the purpose of ascertaining the existence 
of obstruction or obliteration of the eustachian tube, proposes 
the following means: "When, after having accurately closed 
the two ears, a bow is taken between the teeth, and then 
drawn across the strings of a violin, without any sound being 
heard, the eustachian tubes" says he "are obstructed." 

This is also the opinion of Haller. "Another route," says 
that distinguished physiologist, "by which the sonorous vibra- 
tions of the air may reach the organ of hearing is that of the 
eustachian tube. Indeed, it appears that in cold-blooded 
animals it is the principal avenue of sound."* 

It is possible that such may be the fact in the latter class of 
animals; but in man, both experiment and observation tend to 
disprove such a function of the eustachian tubes, as well as to 
reject, as symptoms of their obstruction or imperforation, the 
results of the experiment directed by Diemerbroeck, and 
those of the watch held between the incisor teeth; for in both 
these experiments, if the patient hears, it is a proof that the 
auditory nerves are in a healthy state, and not that the tube is 

* Dictionnaires de* Scicwcs. t. xxix, in 4 to- p. 175. 

19 



# 



146 

unobstructed. The following facts substantiate that which I 
have advanced. 

An individual, fifty-nine years of age, had the eustachian 
tube and the cavity of the tympanum perfectly free, a circum- 
stance which 1 ascertained by the following experiments: — 
First closing his mouth and nose, and then making a strong 
expiration, he perceived the air to pass into the internal ear, 
and to strike upon the membrana tympani. He experienced 
the same sensation when he blew the nose. I injected the 
tubes and the liquor penetrated to the mastoid cells. These 
experiments clearly proved that the eustachian tubes were 
free; nevertheless, he could not hear the beating of a watch 
when he held it between the teeth. Besides, M. Perole has 
made experiments which prove, to demonstration, that the 
eustachian tube does not serve for the propagation of sounds. 
I have quoted them in a note under the second chapter of 
section ii * 

*When after the external meatus is closed as accurately as possible, we 
place between the teeth a solid conductor, in contact with a sonorous bcdy 
which is vibrating, we then perceive the sound to be slightly modified. 
This experiment would seem to indicate that, in this case, the eustachian 
tube transmits some of the sonorous undulations to the ear. We can, how- 
ever, give a reason for this phenomenon without recurring to that expla- 
nation. Sounds may influence us in two ways, 1st, by the vibration of 
sonorous bodies; 2d, by the undulatory motion which the vibrating body 
communicates to the air. This being established, it is obvious that the 
teeth, or any other osseous part, in direct communication with the auditory 
apparatus, may, when in contact with a vibrating body, communicate the 
motion even to the interior of the ear and produce the perception of sound. 
But the sonorous undulations communicated to the air by the same body, 
cannot be perceived by the ear, but through the external auditory meatus, 
the eustachian tube appearing to have no other use but that of renewing 
the air in the cavity of the tympanum. 

We may presume then, that the person of whom Saissy speaks, who 
could not hear the beating of a watch placed between the teeth, had some 



147 

Diemerbroeck gives also, as a sign of obstruction of the 
eustachian tube, the buzzing noise and ringing of the ears. 
The buzzing is not a symptom of obstruction of the tubes. 
The individual whom I have just mentioned experienced a 
good deal of ringing and buzzing of the ears, although these 
passages were perfectly free. I could cite many facts analo- 
gous to this. 

Cooper, in relation to this point entertains an opinion 
counter to that of Diemerbroeck: "When the defect of 
hearing," says Cooper, "is owing to an obstruction of the 
tube, there is none of that roaring sound in the head which 
accompanies nervous deafness."* I am in possession of facts 
which prove the contrary. 

Lentin, for the purpose of ascertaining whether the eusta- 
chian tube was closed, proposed the following experiment: 
He laid the head upon a table, in such a manner that the 
affected ear was uppermost, and in a horizontal attitude. He 
then filled it with warm water and waited a short time to 
ascertain whether the tympanum was perforated or not. If it 
were so, the liquid would pass through the hole and enter the 
throat. He also directed the patient to close the mouth and 
nose, and to force outward the air which he had inhaled. If 
the tympanum were perforated, bubbles of air would escape 
to the surface of the water. On the other hand if the mem- 
brana were entire, the air introduced into the tube would 
cause a protusion of the membrana tympani toward the ex- 
ternal auditory meatus, and cause as much water to flow from 
the cavity of the ear as would be displaced by the convexity 

deep-seated defect of the organ of hearing, perhaps even a complete de- 
struction of the small bones, or the nerves concurring to form the au- 
ditory apparatus. Th. P. 
* Bibliothique Germanique, t. viii, p. 408. 



148 

of the membrane. This circumstance proves that the tube k 
free in its whole extent.* If it be obstructed, the water will 
preserve its level, will none of it flow out, and no bubbles of 
air will escape. 

The reasoning which Lentin employs in the latter case 
does not appear to me to be so conclusive as the author seems 
to regard it. If we suppose, with him, that the membrana 
tympani is entire, the tube clear, and that after a strong expi- 
ration, a part of the water contained in the auditory meatus 
escapes, how shall we be assured whether the water escapes 
in consequence of the impulse of the air upon the membrana 
tympani, or of the involuntary motion of the head caused by 
a violent expiration. The same objection, in all its force, 
obtains against the second part of the conclusion. 

The symptoms which I have described, in the chapter 
which treats of closure and obliteration of the eustachian 
tube, belong also to obstructions of this passage, whatsoever 
may be the nature of the substance with which they are filled. 
But besides these signs there are characteristic criteria which 
indicate the particular kind of matter which obstructs the 
tube;* for instance: 

If the individual becomes deaf after having experienced 
frequent defluxions, and protracted catarrhs, we shall be au- 
thorised to believe that the deafness is produced by an accu- 
mulation of mucous matter in the cavities of the eustachian 
tube and its expanded orifice. 

If deafness comes on gradually, in consequence of syphilis, 
or any other disease, without any affection of the fauces or 
nares — the defect of hearing remaining although the disease 
which gave rise to it may have been cured, it is then to be 

s 

*This is also applicable to the cavity of the tympanum and to the 

mastoid cells. 



149 

presumed that the deafness proceeds from a chalky substance 
obstructing the tube.* 

This presumption will become perfect conviction, if, by the 
aid of a canula, a blunt probe be conveyed into the eustachian 
tube. The resistance which the extremity of the instrument 
will encounter, and the absence of all pain during the exami- 
nation, will indicate the nature of the obstructing substance. 
Finally, if, on injecting the canal, the liquid does not pene- 
trate into the cavity of the tympanum, and if, at the same time, 
small chalky particles are attached, which the patient dis- 
charges by the mouth and nose — all these circumstances com- 
bined must remove all doubt in regard to the immediate cause 
of the deafness. 

If, after a cold, or catarrh of the throat and nasal fossae, 
deafness persists or follows, and a difficulty is experienced in 
probing the tube, we may be assured that the pituitary mem- 
brane, which lines the porch of the tube, has become swollen. 

None of the several species of obstruction, the traits of 
which we have given, will be found to resist the treatment 
which we are about to recommend.f 

Treatment. — We shall here direct our attention only to the 
obstruction of the eustachian tube. We shall suppose, as we 
have done in other instances, that the disease which may have 
produced the obstruction no longer exists, and that there 
merely remains the local disease. 

Many modes of removing obstructions from the eustachian 
tube have been devised, such as, 1st. Injections thrown into 

* Syphilis often producing difficult hearing and even complete deafness 
without the concurrence of any of those causes of which I have spoken. 
I shall cite instances of it in the course of this work. 

t We, nevertheless, except the engorgement of the pituitary membrane 
which must be combatted with repeated purgatives, blisters, and even a 
seton in the neck. 



150 

the canal, by instruments introduced through the mouth; 2d, 
by instruments conveyed through the nose; 3d, by introducing 
into the canal, by a forced expiration, some detergent liquid 
with which, for that purpose, the mouth and nose have been 
filled; 4th, clearing away the mucous matters which accumu- 
late in the orifice of the tube and about it; finally, the opera- 
tion of perforating the mastoid apophysis has been proposed 
and performed, to the consideration of this, however, it is 
not necessary for us to recur. 

I shall not, in this place, rigidly pursue the chronological 
order in which these different methods have been proposed, 
or practised. I shall describe last in order, that to which I 
give the preference. 

1st. Of the method of injecting the eustachian tube through 
the mouth. — This method was first recommended early in the 
last century, and was devised by Guyot maitre des postes of 
Versailles. The celebrated Sabatier states that Guyot had 
acquired a knowledge of anatomy from motives of mere 
curiosity. His own misfortune induced him to study particu- 
larly the structure of the ear. After having conceived the 
idea of curing himself by injections thrown into the eustachian 
tube, he undertook to construct an instrument suited to this 
end, and by the use of which he recovered the faculty ot 
hearing* 

In 1724, Guyot presented the syringe which he had in- 
vented to the Royal Academy of Sciences. This instrument 
is a double pump with a common reservoir, moved by two 
handles, situated on opposite sides, and worked by a row of 
teeth attached to a cog-wheel. From the middle of the reser- 
voir there issues a leather tube, to which there is adapted 
another tube of pewter which is curved. "The essential part 

*Heister, Institutions de Chirurg. t. v. p. 267 



151 

of this apparatus," say the committee of the Academy, u is a 
curved tube, which is passed deep into the mouth, behind 
and above the veil of the palate, in order to apply it to the 
canal of communication which is to be injected. There is 
yet wanting an instrument for injecting the canal by this route. 
That of M. Guyot appears to us to be very ingenious, and 
may serve to wash the mouth of the eustachian tube, which 
will render it very useful in certain cases."* 

It appears from this report, that the committee of the Aca- 
demy did not believe in the possibility of injecting a liquid 
into the interior of the ear, by passing an instrument through 
the mouth into the eustachian tube, and especially such an in- 
strument as that described above, since they say that "it may 
serve at least to wash the orifice of the canal called the eus- 
tachian tube." 

For myself, I think that this was the utmost utility of the 
instrument. Indeed, to be convinced how difficult it would 
be to enter the orifice of the tube with a canula of pewter, 
and how much more difficult still to fix it in the canal it is 
sufficient to examine without prejudice the instrument of 
Guyot, and to observe that the orifice of the eustachian tube 
is directed forward, and that this direction renders it very dif- 
ficult, if not impossible, to introduce a sound into it by con- 
veying the instrument through the mouth. 

Besides these inconveniences, there are others necessarily 
attendant upon the method of Guyot; these are nausea and 
vomiting, excited by the irritation inflicted by the instrument 
on the fauces and the veil of the palate. 

Notwithstanding all the inconveniences which embarrass 
this method, its author merits our respectful remembrance. 
The praise which the Royal Academy, and the most distin- 

* Mem. de 1'Acad. Royale des Sciences, annee 1724. 



152 

guished members of our profession, bestowed upon his in- 
vention, were justly merited. 

Sauvages speaks of the method of Guyot, but in such a 
manner as to induce us to believe that he had not a correct 
knowledge of the instrument or the mode of using it. The 
following is his account of it: "This instrument is made with 
a tube of lead fitly curved, which is introduced into the nose,* 
and by this means dicutient medicines are conveyed through 
the tube and into the ear. Dropsy of the organ is thus cured.f" 

Sabatier thought that further enquiry ought to be made to 
ascertain whether injections might really be thrown into the 
tube, or whether, as the committee of the Academy remark, 
their use is limited to merely washing the expanded orifice. 
The translator of Heister's Institutes of Surgery says, in 
relation to this subject: "The difficulty of finding the orifice 
of the eustachian tube, in order to fit to it the tube of the 
syringe, gave rise to this suggestion. It would even appear 
that when the orifice is found, the liquid could not well be 
made to enter, because of the resistance of the air enclosed 
in the cavity of the internal ear. "J 

The air contained in the tube, in the cavity of the tym- 
panum and the mastoid cells presents no obstacle to the en- 
trance of the injected fluid. The specific gravity of the 
latter, the force with which it is injected, however slight that 
force may be, are sufficient to expel the air which makes its 
way between the walls of the tube and the sound. I every 
day pass into the ear warm injections, sometimes of mineral 
water, sometimes of pure water, or other liquid which I deem 

* We know that Guyot introduced the tube by the mouth. 

t Nosologic, t. ii, p. 219. 

{Heister, Constitutions de Chirurg. t. v. p. 268. 



153 

proper, and always with very little effort. The air of the 
cavity has never opposed the slightest obstacle. 

The editors of the Journal de JWedecine de Paris remark, 
that "although Bell and other surgeons consider it impossible 
to reach the eustachian tube, through the mouth, we neverthe- 
less observe, in the fifth volume of the Memoirs of Rotterdam, 
that Hoaf has accomplished it. He depressed the tongue, 
whilst the veil of the palate was strongly drawn upward by 
means of a strong expiration. He then introduced into the 
mouth a tube, slightly curved and adapted to a small syringe, 
which he directed upwards towards the tube. Nevertheless, 
it is possible," add the editors, "that the injection did not 
penetrate, but merely washed away the mucous matters from 
without.* 

It is obvious from all that we have said, that this method is 
impracticable, or at least very uncertain, both (we again 
remark) on account of the nausea and vomiting that it excites, 
and the almost insurmountable difficulty of entering the orifice 
of the tube, or fixing the instrument when its introduction has 
been accomplished. These numerous difficulties have caused 
even those who have judged most favourably, in regard to this 
method, to doubt whether, by these means, we can succeed 
in conveying liquids into the interior of the ear. All agree in 
believing that the injections merely wash the orifice of the 
eustachian tube. 

2d. In the collection of Theses on surgery published by 
Haller there is found one, read in Paris in 1748, the subject 
of which is another method of throwing injections into the 
cavity of the tympanum. This mode of injecting, if it may 
be called such, consists in filling the nose and mouth of the 
patient with a great quantity of the vapour of water contain- 



20 



154 

ing honey, or some other detergent liquid, and causing the 
patient to force it into the tubes by making a forced expira- 
tion, the nose and mouth being closed. The imperfection and 
insufficiency of this method are obvious to all; I will therefore 
dwell upon it no longer. 

3d. Lentin published in 1793, a small work in latin entitled, 
Tentamen vitiis auditus medendi, inserted in the second volume 
of the commentaries of the Society of Gottingen. He there 
gives a complete description of a method of cleansing the 
orifice of the eustachian tube of the accumulated tenacious 
mucus which may obstruct it. For this purpose he devised a 
canula armed at one of its extremities with a sponge, and of a 
shape suited to the object. The intention of the author was 
to introduce the sponge behind the veil of the palate, without 
touching it, (a thing impossible) as far as the orifice of the 
tube and to press it at intervals from above downward, upon 
the margin of the orifice; the sponge to be previously wet with 
soap and water, or some aromatic wine. By these means he 
deemed it possible to remove the mucus. 

For the sponge, M. Lentin substituted a small piece of veal, 
and as he says completely succeeded without encountering 
any thing disagreeable, that is without causing pain and in- 
flammation by the roughness of the sponge. 

This method is attended with all the inconveniences of that 
of Guyot without possessing its advantages. The latter 
washes at least the orifice of the tube and its vicinity; that of 
M. Lentin, according to his own acknowledgement, irritates 
the parts very much when the sponge is inserted, and the 
piece of veal which is substituted for it glides over the mucus 
without removing it* 

* The improvement which M. Lentin made upon his method is to be 
found in the second volume of his Additions a la Medecine pratique. In this 
work M. L recommends to make injections into the external auditory 



155 

4th. A method which shall be unattended with both the 
inconveniences and dangers of the operation of perforating 
the mastoid apophysis, those which result from the puncture 
of the membrana tympani, and the imperfections, difficulties 
and uncertainty, which the methods of Guyot and Lentin 
present, will undoubtedly merit preference over all these. 
That method consists in injecting the eustachian tubes through 

meatus in the following manner: — The patients head is to be placed upon a 
table, in such a manner as to lie upon the ear which is not to be injected. 
That which is to be injected is then filled with the proper liquid, and after 
having introduced the point of a syringe beneath the surface of the liquid, 
the piston is to be pushed with more or less force. ML Lentin assures us 
that the undulations caused by this manipulation, produce effects superior 
to those of the ordinary mode of injecting. 

The liquid which he most commonly employs is composed of three 
ounces of the infusion of mercurialis or saponaria, a drachm of the gall 
of a calf, and from five to twenty drops of lac ammoniac. 

"A cure has been accomplished by these means" (say the editors of the 
Journal generale de medecine) "of a cure of deafness which resulted from 
a suppuration in the interior of the ear, (without doubt of the exter- 
nal auditory meatus.) The injections removed much membranous mat- 
ter, and hearing having been restored the cure was completed by means of 
the infusion of scordium, with, or without the addition of the oil of myrrh." 

This method of injecting the external ear does not appear to me so su- 
perior to the ordinary mode as M. Lentin supposes. It appears that this 
author ascribes great influence to the undulation produced by the pressure 
of the syringe upon the water contained in the external auditory meatus. 
He thinks that by this undulation the scabs and sloughs are more easily 
and more certainly detached. It may or may not be so; but there is one 
advantage which I discover in this method of washing the external meatus, 
of which M. Lentin does not speak. It is the breaking of the stream of 
liquid which issues from the pipe of the syringe and hence avoiding the 
pain, sometimes very acute, which the injection thrown upon the naked 
surface produces in case of ulceration with intense inflammation. By the 
means proposed by M. Lentin, we avoid all concussion, and painful im- 
pulse, a thing which is impossible, in the ordinary method, whatever pre- 
caution may be taken. 



156 

the nares. I grant that this idea is not new but the instru- 
ments which render this operation altogether easy and safe 
are of a new invention and, in that respect, merit the attention 
of the profession. 

Before I describe the mode of executing this operation, 
and the instruments which are to be used in performing it, I 
shall give a brief historical account of both. 

Douglas, an English physician, (says Sabatier,) first pointed 
out, in his anatomical works, the method of injecting the 
eustachian tube from the nares. 

Cleland, a London surgeon, recommended, in the philoso- 
phical transactions of 1731, a syringe made in the form of a 
flexible catheter, to be introduced into the nose and thence 
into the eustachian tube. 

Sauvages* states that the surgeons of Montpelier use the 
same instrument, but it impossible to form an idea of it 
from the description given by him. 

Jonathan Wathen, another English surgeon, is said to have 
injected the eustachian fc r through the nose. The authors 
of the Leipsick Commt,^ iries speak of the instrument of 
Wathen, and of the rnaniit in which it is used in the follow- 
ing terms: — Utitur autem jistula argentea, commune specillum 
longitudine non super ante, apice, paululum incurvato instruct^ 
et eburnece siringce, tepida aqua rosarum mellita impletw aptata. 
Hanc inter alam et septum nasi hoc modo mgerit, ut ejus 
convexa pars superiorem partem aperturm narium respiciat, 
eamque usque ad orificium ellipticum protradit; tunc ilia pars 
septo obvertitur, ut incurvatus apex tubam facile intrare possit; 
quo facto aqua in earn impellitur, quce mucum per nasum aut 
os, aut per utramque cavitatem eluit. Memorat aliquot surdos 
hoc ratione sanatos operandique methodum icone declarat.'f 

•Nosologie, t. ii. 

jCommentar, Leipsise, anno. 1749, t. viii, p. 147. < 



157 

This account, both of the instrument and the operation, is 
too concise to serve as a sufficient guide to the profession. 

The distinguished professor Sabatier, also invented an in- 
strument for the purpose of injecting the eustachian tube 
through the nose. The instrument is four inches long and 
a line in diameter. The extremity, to the extent of six lines, 
is bent so as to form an angle of 130°. The other extremity 
of the tube has a nut for the purpose of attaching it to a sy- 
ringe. A small projection which is fitted to the other extre- 
mity of the tube serves to show, with precision, what the posi- 
tion of the instrument is when introduced into the nose. 

It is evident from this description that the shaft of the instru- 
ment of Sabatier is straight, with a short curvature at the ex- 
tremity, and that he had but 01 e for sounding both tubes. It 
appears to me that it would be difficult to enter the tube with 
such an instrument, even upon vhe d body, and, on the liv- 
ing subject, impossible. Sabatier himself, also remarks, "that 
which is not difficult in an anatomical preparation may be ab- 
solutely impossible on a living man * 

Leschevin proposes to inject the ^cfstachian tube through the 
nose. "There is but one way," h^Says, "to convey remedies 
directly into the cavity of the tympanum, and that is by inject- 
ing through the eustachian tube. The large orifice of this 
i passage, at the bottom of the nares, will, without much diffi- 
culty, permit the introduction of the instrument. I have often 
performed this operation upon dead subjects of different ages. 
After a few attempts I found no more difficulty than in probing 
the lachrymal canal from the nose. I have used, in these at- 
tempts, a curved blow-pipe, which I introduced through the 
nose."f 

* Heister, Institutions de Chirurg. t. v. pp. 267 et 268- 
f Prix de l'Acad. RoyaJe de Chirurg. t. iv. in 4to. 



158 

M. Leschevin gives no description of his instrument — he 
merely says that it is a curved tube; but has it one or more 
curvatures? This the author does not state. Besides, he ap- 
pears to have confined his attempts to the dead body alone. 

Bell entertains a very different opinion in regard to this ope- 
ration. "It has been proposed," he says, "in case of obstruc- 
tion, to open the passage (eustachian tube) with the blunt ex- 
tremity of a curved probe, or even by injecting with a syringe 
a little milk-and-water or any other bland fluid. But although 
those who have a perfect knowledge of the structure of these 
parts may, after a good deal of experience, perform this ope- 
ration very easily on the dead subject, there is no ground to 
hope that any advantage would be derived from it in practice; 
for the irritation which is excited in those parts, even in a 
state of health, by the extremity of a probe or syringe is so 
great, that all attempts to introduce them must be very uncer- 
tain, and the difficulty must be greatly increased when the ori- 
fice of the tube is obstructed by disease."* 

Bell is not the only one opposed to the method of probing 
the eustachian tube through the nares. Other distinguished 
individuals have entertained, and perhaps still entertain, his 
opinion. 

M. Portal, in his Summary of Practical Surgery, says: 
"Some have thought it possible to inject the eustachian tube, 
by passing the instrument through the mouth. Wathen was 
the first who described the operation.f His remarks may 
be seen in the Philosophical Transactions of the year 1734. 
Certain French surgeons have endeavoured to perfect the dis- 
covery; many have believed that they had succeeded; but un- 

* Bell, Cours complet de Chirurg. t. iv. p. 203. 

f Wathen passed the instrument into the eustachian tube through the 



159 

fortunately their success has not corresponded to their antici- 
pations and I regard their attempts as useless." "It is not pos- 
sible," he adds, "to inject the eustachian tube, either by the 
way of the mouth, or the nose."* 

Dr. Trucy, of Marseilles, in his inaugural thesis defended 
before the School of Medicine in Paris, on the advantages of 
perforating the membrana tympani, in case of deafness caused 
by obstruction of the eustachian tube, after having briefly men- 
tioned the several means which have been employed for the 
purpose of conveying liquids into that passage, and thence in- 
to the interior of the ear, thus expresses himself: "Injections 
into the eustachian tube are then but equivocal means from 
which we cannot reasonably expect any success. "f 

This want of success is owing rather to the imperfections 
of the instruments which are still employed, than to the pecu- 
liar conformation and sensibility of the parts through which 
they are designed to pass. Nevertheless, it is to these cir- 
cumstances that all the inconveniences of the operation are 
attributed by those who have rejected it as a process difficult 
or even impracticable. 

I am persuaded that, by means of the instrument represent- 
ed in the engraving at the end of the work, this operation will 
hereafter be performed with celerity, ease, precision, and with- 
out pain. 

Description. — The instruments alluded to is a tube curved 
in the form of an irregular italic s. The extremity which is 
to enter the tube is obtusely pointed, and the other has an ori- 
fice which receives the' beak of the syringe; on the side of this 
orifice there is a small projecting plate. 

The tubes are four inches long, a line and a quarter in diam- 

* Chirurg. pratique, t. ii. p. 481. 

f Consid. surla perfor. de la memb. dis, tympan. Paris, 1803. 



160 

eter, and have three curvatures, of which the first is three and 
a half lines deep, and begins at the rounded extremity. This 
curvature is in the same plane with the projecting plate. The 
second curvature is three lines deep, and is directed downward 
and to the left, in the instrument which is employed on the 
right side, and to the right in that of the left. The third cur- 
vature is a line and a quarter deep and is turned to the right, 
in the instrument of the left side, and vice versa. 

The tubes which I have just described are of dimensions 
suited to adults and to persons of fifteen or sixteen years. It 
is necessary to employ smaller instruments for children. 

Mode of using the instruments. — The patient should be 
placed in an easy-chair the head slightly thrown backward. 
The operator, standing before the patient, and holding the 
instrument by the external extremity like a pen, with the right 
hand when he is about to pass it into the left tube, the left 
hand or only the little finger resting gently upon the forehead 
of the patient; he then conveys the tube horizontally into the 
nose, the point being directed downwards. As soon as the 
first curvature has entered, the handle is to be depressed, while 
the instrument is passed onward with careful management. 
When the second curvature has completely entered, the round- 
ed extremity of the canula is near the orifice of the eustachian 
tube. He must then execute a movement of rotation inward, 
with the handle, raising this part a little, and at the same time 
applying the third curvature to the septum of the nose. 

The left eustachian tube should be sounded with the left 
hand, the same manipulations being performed which are di- 
rected to be executed on the right. 

We are sure of having entered the tube when the project- 
ing plate, at the external extremity, is directed vertically up- 
ward, when the instrument appears firmly fixed, and when the 



161 

injected liquid returns in part by the orifice of the instrument, 
or appears to issue from it. 

In removing the instrument, the operator should gently draw 
it toward himself and repeat, inversely, the motions which 
were employed in introducing it. 

Persons upon whom the operation is performed for the first 
time experience merely a painful itching, occasional sneezing 
and a slight weeping; but as soon as the parts become accus- 
tomed to the instrument, there is no longer any unpleasant 
sensation. 

The advantages of this method cannot reasonably be disput- 
ed. By means of it we are enabled: 1st, to convey medicated 
liquids into the eustachian tube, the cavity of the tympanum 
and the mastoid cells, and thus to accomplish the cure of deep 
chronic ulcers, with which these parts are often affected. 

2d. To remove from these regions mucous obstructions, 
which may have lodged there in consequence of defluxions 
and catarrhs. 

3d. To evacuate blood which may have accumulated and 
coagulated there in consequence of a blow or fall upon the 
head. 

4th. To dissolve and remove chalky substances, which 
sometimes accumulate in the same cavities. 

5th. By means of the canula which we have described we 
may introduce a stylet, in the form of a trochar, into the cavi- 
ty of the eustachian tube, pierce a congenital membranous sep- 
tum, or a cicatrix formed in consequence of ulcers of the throat 
and fauces. 

6th. Finally, by the same means, if there is any insensibility 
of the acoustic nerve, we may introduce lavements into the in- 
terior of the ear. 

Those who advocate the perforation of the mastoid apophy- 
sis make the following objection to the method of injecting the 
21 



162 

ear, through the eustachian tube, and by a singular inconsisten- 
cy they at once remove it, and refute themselves. 

"This method" they say "is not sufficient to remove the 
cause of deafness, since an injection made in this manner forces 
deeper the substance which causes the obstruction in the cavi- 
ty of the tympanum. It issues^ indeed, with the injected fluid, 
but it is not thrown out with the same force as when the in- 
jection is thrown in through the mastoid apophysis."* 

These, I am persuaded, will be regarged as very feeble rea- 
sons for giving preference to an operation so painful, and at- 
tended with so great danger, over another not in the least pain- 
ful nor accompanied with the slightest hazard. 

I believe that I have established in the most satisfactory 
manner, the comparative advantages of injecting the eustachian 
tube, by the way of the nasal passages, and the utility of the 
newly-invented instruments, by which the operation is accom- 
plished. I shall now point out the cases in which this method 
is impracticable — also those in which it would be unavailing. 
They are: 

1st. Mal-conformation of the nasal passages, 

2d. A polypus located in these cavities. 

3d. A tumid state of the pituitary membrane lining the ori- 
fice of the tube and its vicinity. 

These causes may present obstacles to the introduction of 
the tube into the orifice of the canal. 

When the cause of deafness depends upon induration or os- 
sification of the membrana tympani, or on the lesion of some 
part of the labyrinth, the operation of which I speak will bo 
attended with no favourable result. 

•Journal de Med. Chirurg. Pharm fer. 1793 



SECTION IV. 

On diseases which affect parts in the vicinity of the 
eustachian tube, and which thus give rise to deaf- 
ness, and sometimes to dangerous diseases of the in- 
ternal ear, 

We have just treated of those diseases which directly attack 
the eustachian tube. We will now glance at those which af- 
fect parts in its vicinity, and which from swelling or preter- 
natural growth, compress the tube in such a manner as not 
only to create deafness, but also to produce other diseases of 
the internal ear. These diseases are, inflammatory swellings; 
abscess of the tonsils and of the half-arches of the palate; po- 
lypous excrescences in the posterior nares; and exostoses of 
the internal plate of the pterygoid apophysis. 



CHAPTER I. 

On inflammatory engorgements and abcesses of the tonsils, and 
of the half-arches of the velum palati. 

Abscess of the tonsils and of the half-arches of the palate, 
and the inflammatory swelling which precede them, are the 
result of cynanche tonsillaris. 

The causes, symptoms, and treatment being described in 
many medical works, it would be departing from our particu- 
lar province to dwell upon them here. 

We will nevertheless advert to these diseases so far as they 
may relate to the organ and function of hearing. Indeed, when 
an inflammatory swelling attacks chiefly the posterior palate 



164 

half-arch, it may be propagated to the eustachian tube, com- 
press that canal, and give rise to an inflammation which may 
occasion deafness. When the abscess spontaneously bursts, 
the pus may make its way through the walls of the tube, or 
be poured into the interior of the ear, and there produce alarm- 
ing results. 

It is important, therefore, carefully to distinguish the case 
in which abscess of the posterior half-arch presses upon the 
eustachian tube. The difficulty of hearing, buzzing noises, 
and often an acute pain which shoots through the internal ear, 
are the symptoms by which we ascertain that the abscess is 
very near the eustachian tube. On touching the tumour with 
the finger, a fluctuation more or less manifest will indicate the 
propriety of either hastening or postponing the opening of the 
abscess; nevertheless, we ought to perform the puncturing of 
it as soon as possible. 

The abscess should be opened at the most depending part. 
The mode of opening it, and the instruments which are em- 
ployed, are described in numerous works on operative sur- 
gery. 

I shall finish this chapter with a few instances of this form 
of abscess, chiefly derived from the posthumous works of our 
countryman Jean Louis Petit. 

That author, after having spoken of abscesses seated in parts 
around the ear, remarks: "But there are others, far more des- 
tructive, which attack the internal ear, perforate the membra- 
na tympani, convert the cavity of the typanum into an abscess, 
and destroy the attachments of the muscles of the malleus, of 
the stapes and the incus. I believe, however, that pus is not 
previously formed in that cavity; but that which is deposited 
on the outside of it makes its way there, either through the 
eustachian tube, the meatus externus, or both together. In the 
latter case the pus escapes both by the external ear and by the 






165 



mouth, but not till it has produced alarming symptoms, chills, 
and paroxysms of fever" ******#*. "From what I have stat- 
ed above it will be manifest," continues this celebrated author, 
"that the abscesses of which I speak, having a double issue, 
should be least mischievous, which, however, is not the fact; 
because in this case the matter lingers in the osseous cavities, 
the walls of which cannot collapse. Because it cannot be ex- 
pelled by compression, it remains and produces caries of the 
bones. This caries cannot be treated with any topical 
means; it is even inaccessible to any salutary operation, and 
there is nothing but injections* from which any advantage can 
be derived. Exfoliation, which is the most favourable result 
that can be looked for in the treatment of caries in other parts 
of the body, is ineffectual here, because of the difficulty of 
removing the exfoliating portions. They become in many 
ways productive of mischief, as will be seen in the following 
cases, "t 

The subject of the first case was a man of adult age. He 
had been ill for some time, and had been treated by many sur- 
geons who had declared his case to be incurable. 

After a careful examination, Petit ascertained that the mem- 
brana tympani was destroyed; that the surface of the tympa- 
num was denuded of its pariosteum; that the small bones were 
detached, concealed in a recess of the cavity, and inaccessible 
to the probe, to which place Petit supposed them to have been 
conveyed by suppuration. One day, however, as he was in- 
jecting the ear, the incus and stapes escaped together. The 
orbiculare, stapes, and the long leg of the incus were anchy- 
Iosed so that these three bones formed but one piece. Some 

* Injections, such as we have described, made as soon as pus is deposited 
in the cavity of the tympanum and mastoid cells, will prevent the accidents 
ef which this celebrated surgeon speaks. 

f Petit, (Euvres posthumes, t. i. 



166 

days after the malleus issued, in consequence of an injection 
thrown in with more than ordinary force.* 

"Sometimes," says our author, "pus escaped in great quan- 
tity. After some time I discovered that much more escaped 
than the cavity of the tympanum could contain, and that this 
cavity, of which the walls were bony, could not, of itself, fur- 
nish the whole; hence I inferred that the matter was derived 
from some other scource; and as there are but two ways by 
which pus can enter into the drum — the external meatus and 
the eustachian tube, and as externally there was no swelling, 
and no matter escaped on pressing upon that region, I doubted 
not that the pus entered the cavity of the tympanum from the 
eustachian tube. On passing my finger into the mouth and 
pressing the tonsil, pus passed from it into the cavity of the 
tympanum, from which it was made to issue by throwing in 
injections, which circumstance Caused me to put a few ques- 
tions to the patient He then apprised me of a circumstance 
of which I had been ignorant, which was that before the ear 
became diseased, he had been subject to swellings of that ton- 
sil, which were sometimes spontaneously resolved and some- 
times terminated in suppuration, and to which he had not been 
subject since the suppuration of the ear. This circumstance, 
says Petit, induced me to believe that this abscess, having 
penetrated the eustachian tube, was the source of the pus 
which issued from the ear, and that if there were a sufficient 
quantity to make an opening towards the throat, so that injec- 
tions made through the ear might issue at that opening, 
the ear might be very easily deterged. Indeed, sometime 

* The injections which Petit employed, and which varied according to 
circumstances, were decoctions of barley or aristolochia; sometimes of gui- 
acum or sassafras, with which he often blended the infusion of colewort, of 
vulnerary, plentain, house-leek, &c. &c. 



167 

After this, the left tonsil swelled again, formed an abscess and 
spontaneously opened behind the veil of the palate, so that the 
opening could not be seen. The patient spit up the pus and 
it also escaped by the ear. In order to avail myself of this 
advantage offered by nature, that is of the opening which was 
formed in the throat, I had a new syringe made, the beak of 
which terminated obtusely, so as to fill accurately the canal of 
the external ear, that the liquor injected might not regurgitate, 
but, being urged with some force, might make its way through 
the eustachian tube and escape by the mouth. This perfectly 
succeeded for five days, after which the injection passed with 
difficulty, and by degrees ceased to pass altogether, and the 
patient recovered."* 

The same author reports another case, the subject of which 
was a child which had been afflicted with pain in the ear and 
with loss of hearing in the ear affected, (he does not say 
which.) After one year of suffering the patient was suddenly 
attacked with a chill, after which he had fever accompanied 
with delirium. He was bled in the foot, in the height of the 
attack, after which he fell asleep. Soon after, some One on 
seeing the ear covered with blood and matter, waked him; he 
had no longer any pain, and very soon the fever ceased. 

Lavements of barley-water, to which there was added a 
I little of the infusion of vulnerary, were employed in the latter 
stages of the disease. At the end of twenty-five days, the lit- 
tle bones of the ear, a bony portion of the external auditory 
meatus, and a fragment of the margin of the foraman ovale 
successively escaped. "These cases," says this distinguished 
author, u are always very tedious, and they do not in every 
instance terminate so fortunately." 

The facts which I have adduced in the above extract are 

* Ouvrage cite. 



168 

rery interesting in two respects. In the first case we observe 
a severe disease having its primary seat in the posterior part 
of the left tonsil and in the external half-arch of the velum pa- 
lati. This abscess, after opening- and closing many times, 
makes its way through the walls of the eustachian tube; the 
pus is poured into the cavity of the tympanum, destroys the 
membrane which lines it, disorganises and detaches the small 
bones, and finally bursts through the membrana tympani. 

This disease had continued twelve years. It was not till 
after another swelling of the tonsil of the same side, which 
formed an abscess that burst at the most depending part, be- 
hind the velum palate, and after the employment of detergent 
injections, that the source of the purulent secretion was dried 
up and the patient cured, but with loss of hearing in the left 
ear. 

If Petit had had charge of this patient, at the commence- 
ment of the first swelling, I doubt not that he would have pre- 
vented the rupture of the abscess into the eustachian tube by 
cautiously incising the tonsil. By this operation, which is un- 
attended with difficulty or danger, he would at once have pre- 
vented this protracted suffering of the patient, and have pre* 
served a valuable organ.* 

* The following case goes to prove the truth of this assertion: 
"Rosalie C***," says Dr Perreymond, "had been very subject to cynanche 
tonsillaris. For more than a year the enlargement of the right tonsil was 
accompanied with a ringing and a degree of deafness in the ear of that side. 
The patient had an attack of quinsy in December, 1809; the disease was 
preceded by chills, and some degree of delirium occurred after bleeding 
from the arm. The patient slept for some hours, and while sleeping, her 
cap and her ear were deluged with bloody pus, which issued from the right 
auditor}' meatus. The pain and delirium ceased, but a slight discharge still 
continued from the ear. Some time after this there occurred a new attack 
of quinsy, and the discharge from the meatus ceased. Notwithstanding the 
frequent repetition of detergent injections, the antiphlogistic means directed 



169 

This might have been accomplished, indeed-, after the ab- 
scess had burst into the eustachian tube, by the injection of 
emollient and detergent liquids into the cavity of the tympa* 
num. Had a cure not been affected, the pus might at least 
have been prevented from lingering in the interior of the ear 
and causing the mischief detailed above. 

It appears that in this subject the eustachian tube became 
obliterated, or obstructed, near its internal orifice in conse- 
quence of inflammation. For had this canal been free, the pus 
would have issued, at least in part, by the mouth and nOse, and 
the injections which were thrown into the external meatus 
would not have ceased to pass by the eustachian tube; where- 
as, after the cicatrisation of the accidental opening in the tube, 
the injections passed neither by the mouth nor the nose. 

The disease in the second case was more profound; the seat 
of the abscess was, chiefly at least, in the internal ear itself. 
The unexpected discharge of pus from the external ear, the 
escape of the small bones in succession, and of fragments of 
the bony ring of the auditory meatus, and of the foramen ovale, 
after the employment of injections for five days, left no doubt 
in regard to this. 

Hereafter such a state of things should be opposed by the 

against the inflammations) did not prevent the right tonsil from becoming 
Very large about the tenth day, and the occurrence of sordes upon the parts 
in its vicinity, with fetid exhalations from the mouth. The tongue being de- 
pressed by means of a spatula, and the jaws kept apart by the interposition 
of a piece of cork between the molar teeth, the abscess was opened with a 
pharyngatome. There issued from it pus and a quantity of black blood. 
The operation instantly assuaged the disease and the employment of deter- 
gent gargles completed the cure. From that time there was no more dis- 
charge from the meatus, pain, or difficulty of hearing in the right ear. The 
patient made habitual use of the prophylactic gargle of Quarin, composed 
of the infusion of sage leaves and red roses, together with the anodyne li- 
quor of Hoffman.' 4 
£9 



170 

seasonable employment of emollient injections through the 
eustachian tube. Under such circumstances the injections 
should be thrown in with much address, in order to avoid irri- 
tating parts already inflamed and painful in the extreme. Af- 
ter these injections, we should make use of those which are of 
a detergent quality, such as the water of Balaruc and Barege9, 
or rose-water with honey, &c. 



CHAPTER II. 

On catarrhal engorgement of the tonsils and palate half-arches, 
and the mucous deposits which cover and surround the inter- 
nal expansion of the eustachian tube. 

This affection always arises from catarrhal inflammation of 
the tonsils. The symptoms are a slight degree of pain, a lit- 
tle hoarseness and occasionally some difficulty of respiration 
and deglutition. The parts affected are of a pale red colour, 
and covered with a coating of mucus. The degree of deaf- 
ness is in proportion to the magnitude of the swelling and to 
the quantity and tenacity of the mucus. 

I have recently treated a young man, twenty years of age, 
whose case furnished an instance of deafness occasioned by 
chronic catarrhal engorgement of the tonsils, and by mucus 
which surrounded the orifice of the eustachian tube. 

This case yielded to blisters applied to the arms, a seton in 
the neck, repeated purgatives, and injections into the eusta- 
chian tube. 



171 



CHAPTER III. 



On polypus in tJie posterior nares, and other bodies which may 
compress the eustachian tube and thus produce deafiuss. 

Valsalva states that deafness occasionally results from clo- 
sure of the eustachian tube. He relates two instances of it; 
one of a gentleman who lost his hearing in consequence of 
a polypus in the nose, which extended as far back as the 
uvula; the other of a countryman who had an ulcer on the left 
side of the uvula. When a tent, dipped in some detergent 
liquor, was placed upon the part the patient heard nothing 
with the left ear, but he recovered his hearing in that ear as 
soon as the tent was removed. 

Tulpius also speaks of deafness and ringing of the ears caus- 
ed by a tumour of the palate, near the tube. 

The causes, symptoms, and treatment of this disease being 
given in the practical works of medicine, and, indeed, the dis- 
ease having but an indirect relation to the diseases of the inter- 
nal ear, I do not think it proper to enter into details on the 
subject. 

The Memoirs of the Academy of Sciences for 1705, men- 
tion a very remarkable fact. A young man, twenty years of 
age, became suddenly deaf-and-dumb, from having his throat 
pinched by a very strong man, with whom he had an affray. 
All the remedies which could be devised were found ineffec- 
tual. 

It is to be presumed that the excessive turgescence of the 
tonsils, of the palate half-arches, and of the pituitary mem- 
brane which lines the orifice of the eustachian tube, caused by 
the violent compression of the throat, was the cause of the 
deafness; and that some injury of the recurrent nerves was the 
cause of his becoming dumb. 



172 

Without being sceptical, we may doubt the correctness of 
the above assertion, at least in regard to the permanent effect 
of the compression upon the organ of hearing; for it is not to 
he believed that the engorgement of the parts which surround- 
ed the orifice of the tube would not subside in the course of a 
few days, and that the patient would not recover, at least in 
part, the faculty of hearing. 

Nevertheless, there is one circumstance which might lead to- 
belief in the continuance of the deafness, after such an injury. 
This might be the case when an extravasation of blood has re* 
6ulted from such a degree of violence, and when that fluid has 
been poured into the canal of the tube, or into the cavity of 
the tympanum and has coagulated there. The memoirs also 
state "that all the remedies which could be devised were found 
ineffectual." But what these remedies were they dG not state. 

Were such a case to occur to me, I would employ the fol- 
lowing means: Bleeding from the arm, repeated according tir 
circumstances; leeches to the neck; sinapisms to the feet; low 
diet; diluent drinks. 

If, notwithstanding these means, the engorgement were not 
dissipated, which, however, can hardly be supposed, I would 
not hesitate to scarify the fauces, and especially the tonsils and 
the palate half-arches. I would apply a large blister between 
the shoulders, and another on the anterior part of the neck. 
These means I am persuaded would suffice to disperse the 
swelling however considerable it may have been. 

If, after the complete resolution of the swelling of the throat, 
the deafness should continue in the same degree, we should 
have reason to presume that there was an extravasation of 
blood, or some other fluid, in the cavity of the tube or that of 
the tympanum. Then injections of warm water merely, 
thrown into the eustachian tube, would suffice to restore the 
functions of the organ of hearing. 



SECTION V. 

ON DISEASES OF THE LABYRINTH. 

The labyrinth may be affected with the same diseases 
which affect the cavity of the tympanum. I shall limit my 
observations: 1st, to those of the membranes of the foramina, 
fotundum and ovale; 2d, those of mal-formation in these fora- 
mina; 3d, those of mal-formation of the labyrinth; 4th, inflam- 
mation of the membrane which lines the cavities of the laby- 
rinth; 5th, degeneration of the liquor of Cotunnus; 6th, defi- 
ciency of that fluid. Mundini found the cochlea consisting 
merely of one spiral turn and a half.* 



CHAPTER L 

On the diseases of the membranes of the foramina, rotundum 
and ovale. 

"These membranes," says Leschevin, "may, in old age, 
become thick, hard and dry, as does the tympanum. Besides, 
the membrane of the foramen ovale may also become relaxed 
by destruction or paralysis of the muscle of the stapes, which 
muscle, in its natural state, serves to render this membrane 
tense."f 

Valsalva thought that the opening of the foramen ovale was 
closed by a membrane like that of the foramen rotundum. He 
asserts that he has found it ossified in the ear of a deaf person.^ 

• Opusc. Acad. Danor. 1791, t. vii. 

f Prix de l'Acad. de chirurg. t. iv. in 4to. 1 re. partie. 

| Valsalva, t iv. p. 306. 



174 

The causes and symptoms of thickening, induration and re- 
laxation of these membranes, are the same as those which cha- 
racterize the same affections of the tympanum. 

No remedial means can be employed in the two first affec- 
tions. For relaxation of these membranes, We may employ, 
with advantage, the means pointed out in chapter second of 
the first section. 

The membranes of which we speak may be corroded and 
destroyed by suppuration. M. Leschevin, in his memoir on 
diseases of the ear, has given instances of it. 

This lesion is irremediable, and the patient loses, without 
hope of recovery, the faculty of hearing in the affected ear, 
because the liquor of Cotunnus escapes and leaves the nervous 
pulp, which lines the semicircular canals and the cochlea, in a 
dry state. This nervous tissue we know to be the immediate 
seat of hearing. 



CHAPTER II. 

On mal-conformation of the foramen rotundum and of the 
foramen ovale. 

These openings, the first of which, in its natural state, is 
closed by a membrane like that of the tympanum, and the se- 
cond by the base of the stapes to which it is united by a deli- 
cate ligamentous substance which hermetically seals it; these 
openings, I say, by primary mal-formation, may be preternatu- 
rally small or altogether wanting. Of this we have related a 
case already. The following is another instance of their being 
preternaturally small. 

"In the temporal bone of a full-grown foetus, I found," says 
M. Lobstein, "the foramen rotundum of the tympanum ex- 
tremely small, forming a very oblique opening which scarcely 



175 

admitted a small probe. If, as Scarpa assures us, the size of 
this foramen diminishes with the advance of age, and if it be 
smaller in the aged than in the young, this foetus, in process of 
time, should necessarily have had it closed. The remark, it 
appears to me, deserves to be repeated. It points out a new 
source of deafness, depending upon mal-formation of the inter- 
nal ear. I have observed," continues the professor, "that the 
construction of which I speak was produced by super-abund- 
ance of the osseus matter in the midst of which this foramen 
is formed. Cotunnus has made a similar remark in regard to 
a foramen which was already totally closed. Is it not possible 
that such a disposition may exist in the foramen ovale; and that 
the promontory becoming more elevated and larger in all its 
dimensions may render this foramen smaller, and thus push 
from its place the stapes which occupies it? I am confident 
that, on carefully examining the organ of hearing in its most 
obscure* parts, we shall greatly enrich the history of diseases 
of the ear."f 



CHAPTER III. 

On mat-conformation of the labyrinth. 

Nature may leave something imperfect in the structure of 
the labyrinth; either in the vestibule, the cochlea, or the 
semicircular canals; or, if we may so say, may have neglected 
the organization of the labyrinth altogether, as appears from 
the following fact: 

"A child in the alms-house of this city appeared to have 

* It is to be desired that physicians to deaf-and-dumb institutions should 
suffer no opportunity for port-mortem examination to escape them. 

| Rapport sur less travaux anat. de Tecole de med. de Strasbourg, premier 
trimestre de Pan xii. 



176 

been deaf from birth. The loudest sounds did not appear to 
make any impression upon him; nevertheless he uttered im- 
perfectly some syllables, and he was prompt in seizing the 
expression of the lips and of gestures. This child having at 
length died of an adynamic fever, the dissection of the 
organ presented the following condition of the parts." 

"The external ear was well formed, and the membrane of 
the tympanum was in its natural state; but the cavity of the 
tympanum was filled with a mucilaginous matter. No traces 
of the small bones were found. The eustachian tube was in 
its natural state. The immediate organ of hearing was en- 
tirely absent; that is, the vertibule, the cochlea, the semicir- 
cular canals and the foramina, rotundum and ovale, were 
altogether wanting."* 

Does there exist any symptom which may enable us to 
ascertain or at least to presume the existence of mal-forma- 
tion? The following I regard as data which indicate it 
Besides that the individual will be completely deaf, he will 
not perceive the beats of a watch when the handle is held 
between the teeth; nor will he perceive the sound of a 
stringed instrument, when the experiment of Diemerbroeck is 
repeated. Under these circumstances one may be sure that 
the immediate organ of hearing is wanting, or that it is essen- 
tially defective, and that the deafness is incurable. 

But if it be merely a collection of mucus which obstructs 
the cavity of the tympanum, the mastoid cells or the eusta- 
chian tube (and this is very often the case with congenital 
deaf-mutes) the patient will be less completely deaf; besides, 
on making the experiments which we have directed, he will 

* I have derived this case from M. Montain, Jun. doctor of Medicine and 
surgeon-in-chief to the hospital de la Charite de Lyon. 



177 

hear the beats of a watch and the tones of the musical 
instrument. 

In the latter case nothing is necessary to make the indi- 
vidual hear, but to relieve the organ of the mucous matters 
which obstruct it, and to stimulate it slightly. Both objects 
will be accomplished by means of injections thrown into the 
interior of the ear. These injections should at first be 
emollient, and then tonic. These simple means will suffice to 
recover the organ of hearing from the state of insensibility in 
which the want of exercise will have kept it. 



CHAPTER IV. 

On inflammation of the nervous tissue of tlie labyrinth. 

We give the term otitis to acute inflammation of the mem- 
brane which lines the cavities of the internal eat, but espe- 
cially to that which affects the nervous substance which lines 
the cochlea and the semicircular canals. 

I shall adduce two instances to show that the nervous tissue 
of the labyrinth is susceptible of a very intense inflammation. 
My colleague Dr. Viricel former surgeon-in-chief to the Hotel 
Dieu of this city, furnished me with the following cases: 

"On the 16th of February, 1806, a patient in the surgical 
ward, who had merely a small ulcer upon the left leg, and 
who lay opposite a window, was attacked in the night with 
an acute pain in the interior of the ear. The pain was ac- 
companied with a violenf fever which I thought to be of the 
catarrhal character. Five hours after the occurrence of these 
symptoms, the patient became delirious, apparently in conse- 
quence of the extreme pain and intensity of the fever. Inter- 
nally I gave soothing anodyne remedies; applied a blister to 
the left arm, and directed the application of a mustard paste to 
23 



178 

the neck; but notwithstanding the use of these means together 
with injections and pediluvia strongly charged with mustard, 
the symptoms increased and the patient died on the third or 
fourth day after the attack."* 

"This individual, vigorous, and of an arid, bilious tempera 
ment, died so suddenly that I wished to ascertain the condi- 
tion of the parts which had been the seat of the disease. I 
discovered no marks of disease in the brain; but on exa- 
mining with great care the interior of the ear, I found the drum 
almost completely filled by the mucous membrane, which had 
become swoollen and was of a dark-red colour. The cavi- 
ties of the cochlea and semicircular canals contained matter 
of the colour of iron-rust, and like reddish pus; from which 
I concluded that a very active inflammation of several deep- 
seated parts had caused the death of the individual." 

"Five days after the death of the person of whom I have 
been speaking, another patient, about fifty-five years of age 
entered the hospital on account of a pain in the right ear. 
The fever and pain had been present for twenty-four hours. 
Directed by the port-mortem examination which I had re- 
cently made, I immediately applied leeches behind the ear, a 
blister to the neck and other means which I have named above; 
but they were not attended with success. The symptoms 

* We may with propriety query whether such would have been the result 
had means more energetic and appropriate been employed. The practice 
in the above case was obsolutely puerile. Trusting to soothing means 
under such circumstances, is like attempting to restrain the violence of a 
raving mad-man with bland words instead of putting him at once in a 
strait jacket. 

This patient should have been freely bled, both generally and locally; cold 
applications should have been applied to the head, and, indeed, the whole 
phalanx of antiphlogistic means should have been put in requisition against 
an intense inflammation which had evidently seized upon an important 
organ. N. R. S. 



179 

persisted; on the fourth day delirium supervened; on the 
seventh the patient uttered agonizing cries, which the pain 
extorted from him. Pain, which opiates given in large doses 
were unable to subdue, terminated his existence." 

"On opening the body I found the cavity of the tympanum 
filled with a viscous matter like pus, and very thick. The 
semicircular canals were filled with a serous fluid which 
seemed alone to occupy these cavities, with the exception that 
there were portions of membrane of a red colour." 

"These facts would induce me in similar cases to apply, fn 
the onset of the diease, a blister upon the ear. This remedy 
has with me been successful in many cases which occurred 
during the same epidemic constitution of the atmosphere 
which prevailed in February, and which continued for three 
months in 1806, as is manifest from records made by me at 
that time." 

From the facts reported above it is obvious that a damp 
and cold atmosphere, and the repulsion of an accustomed 
purulent discharge were the efficient causes of the form of 
inflammation which we describe. 

Intolerable pain in the ear, intense fever and delirium, are 
the symptoms which characterize this formidable disease.* 

* I believe that in cases like those quoted above we may confide irl the 
good effects of general bleeding, copious and frequently repeated, also of 
emollient cataplasms applied over the temporal and mastoid regions of the 
diseased side. The ear having but few capillary vessels, would be but 
little influenced by leeching; but when after the employment of this treat- 
ment the symptoms persist, we should presume that they depend upon a 
collection of pus filling the cavities of the internal ear and compressing 
the organs which are lodged there. In this case ought we to endeavour to 
favour the escape of the pus by injections thrown into the eustachian tube? 
I think that, in consideration of the severity of the symptoms; the diffi- 
culty that would be experienced in performing the operation upon a patient 
suffering so intensely, and often delirious, and the pain that would be occa- 



180 

This is a case for prompt and vigorous treatment; the least 
delay, even the loss of a moment may be fatal to the patient. 

At the onset of the disease, blisters should be applied 
around the ear as was done with so much success by M. Vi- 
ricel; bleeding from the arm of the diseased side, repeated 
according to the intensity of the symptoms; leeches to the 
temples; pediluvia strongly charged with mustard; emollient 
injections; and if the otitis is caused by the healing of an 
ulcer, or any other issue, we should hasten to restore the 
suppressed discharge. 

The regimen should be severe; veal or chicken water, and 
light broths are proper for nourishment. Ptisans of mucilage 
with nitre, and of whey, should be the ordinary drinks. 

I would not recommend the employment, either internally 
or externally, of any variety of narcotic. Experience has 
often shown that in acute inflammations they are rather inju- 
rious than useful. 

I see no objection to the introduction into the cavity of the 
tympanum and mastoid cells, by the eustachian tube, of warm 
milk combined with the decoction of the flowers of mallows, 
&c. These liquids, injected with extreme care, will operate 
as an internal bath which cannot but have the happiest effects. 

The treatment should be concluded with the employment 
of one or more purgatives, according to the exigency of the 
case, in order to hasten the resolution of the engorgement of 
the membranes which have been inflamed. 

Should the inflammation terminate in suppuration, hearing 
will be lost without hope of recovery. But we ought, at 

sioned by the instrument in parts participating in the inflammation, we 
ought to employ means more prompt, easy of application and safe — lo 
make an opening in the membrana tympani without delay, and then to fa- 
cilitate the discharge of the pus by injections of warm water thrown into 
the external orifice of the ear. Th. P. 



181 

least by the employment of injections into the internal ear, to 
deterge the ulcer, remove the pus, and rescue the patient from 
a digusting and even dangerous disease. 

When the inflammation terminates in gangrene, death soon 
follows. We have given two instances of it. 



CHAPTER V. 

On degeneration of the liquor of Cotunnus. 

This fluid is susceptible of being changed in its character. 
Mr. Cline, an English surgeon, on dissecting the body of a 
deaf-mute, found the vertibule, the cochlea and the semicircu- 
lar canals filled with a substance which had the consistence of 
cheese, instead of the liquid which they ordinarily contain. 

What can be the cause of such a degeneration of this li- 
quor? Experience and observation are as yet silent in regard 
to this point. We may at least endeavour to establish the 
diagnosis of that form of deafness in which the disease arises 
from obstruction of the labyrinth, resulting from degeneration 
of the liquor of Cotunnus. 

If injections, thrown into the eustachian tube, pass freely 
into the cavity of the tympanum, and thence into the mastoid 
cells, which will be ascertained by the impulse which the 
injected liquor makes upon the membrana tympani, and a 
kind of slight itching which the patient will feel in the 
mastoid region, and if, on repeating the experiment with the 
watch, and with the strings of the musical instrument, the 
individual hears the sounds of neither, one may be almost 
certain that the disease is located in the labyrinth. 

This cause of deafness cannot be removed by any means at 
present known to us. 




182 

CHAPTER VI. 
On the wasting of the liquor of Cotunnus. 

"The wasting of the liquor of Cotunnus," says M. Riche- 
rand, "produces dryness of the labyrinth, which gives rise to 
deafness in consequence of induration of the accoustic nerve. 
This is a frequent cause of the deafness of old age."* 

Undoubtedly Professor Richerand has collected facts which 
substantiate the latter assertion*, it is, therefore, to be desired 
that he had related some of them. 

Another more frequent cause than that of old age conduces 
to the wasting, or rather the evacuation of the liquor of Co- 
tunnus; this is long-continued suppuration in the cavity of 
the tympanum, which terminates in the destruction of the mem- 
brane, closing the foramen rotundum, detaching the small 
bones and hence effecting the opening of the foramen ovale, 
closed by the base of the stapes. 

One of these barriers being destroyed, the liquor is poured 
into the cavity of the tympanum and flows out by the eustachian 
tube. The labyrinth remains empty, the acoustic nerve is no 
longer impressed by the undulations of the liquid contained in 
it, and the perception of sounds is destroyed. The patient 
will hear, it is true, the sound of thunder, of artillery, bells, 
and even of a drum; but the most distinct sounds of the voice, 
and those given by musical instruments are never heard. 
The following case substantiates this assertion. 

A young man deaf-and-dumb from birth, sixteen years of 
age, heard the sound of cannon and of thunder, he also heard 
the beating of a watch both when it was applied to the ear, and 
when the handle was held between the teeth. When any one 
spoke to him through a hearing trumpet, he heard the noise 

* Nouv. Elem. de Physiol, t. ii, sens de V ou'ie. 



183 

but not the articulate sounds. He imitated the noise which 
he heard but uttered no distinct syllable. 

When any one struck upon a table behind him, he counted 
the blows with his fingers, which he ceased to do when the 
blows ceased. 

An injection thrown into the eustachian tube penetrated not 
only into the cavity of the tympanum and mastoid cells, but 
even into the labyrinth. He signified this by the circular 
movement of his hand around the ear. This last circum- 
stance I regard as a sign indicative of the destruction of 
the membrane of the foramen rotundum or of the separation 
of the base of the stapes from over the foramen ovale. 

Art furnishes no means by which to remedy the defect of 
structure of which we have been speaking. 



SECTION VI. 

ON DISEASES OF THE ACOUSTIC NERVE. 

The disease which most frequently affects the acoustio 
nerves is palsy. 

There are many causes which may produce this affection; 
as, for instance, the translation of some morbific humour, a 
sanguineous congestion, steatoma, an exostosis, worms in the 
stomach, &c. &c. 

We find in the MSmoires des Curieux de la Nature (decade 
3. e, articles 7 et 8, observation 103 e.) an account of a man 
sixty years of age, who, immediately after having been cured 
of deafness, was attacked with palsy of the right side, which 
circumstance could not but be regarded as a metastasis. 

Drelincourt found in the head of a man who died of apo- 
plexy, a steatomatous tumour between the cerebrum and cere- 
bullum, which had at first produced blindness, afterwards 
deafness, and finally an abolition of all the animal functions.* 

Compression, or obstruction of the auditory nerve, may be 
confined to the nerve itself, or be extended to the cerebral 
mass. In the former case the deafness may occur at once, or 
gradually, and the organ of hearing is the only part which 
suffers; but in the latter case, deafness is preceded by stupor, 
paralysis, or the abolition of some other sense.f 

Each of these causes has its peculiar mode of acting on 
the acoustic nerve and its own peculiar symptoms. The 
difficulty is so to discriminate these phenomina as to be able 

* Bonnet, Anat. pratiq. sect. 2, obs. 53. 
t Duverney, Traite de l'ouie p, 157. 



185 

to distinguish one cause from another. Until our science 
shall have reached this point, our prognosis will be vague and 
our treatment uncertain. 

The peculiar circumstances which may have preceded the 
palsy may, nevertheless, throw some light upon this subject. 
For instance; if in consequence of a blow, or a fall upon the 
head, with or without hemorrhage from the ears, the nose, or 
the mouth, the patient becomes suddenly or gradually deaf, 
we may presume that extravasation of blood is the imme- 
diate cause of the deafness. 

But where will this extravasation have taken place? In the 
cavity of the tympanum or in the internal temporal fossa, near 
the petrous portion of the temporal bone? I have pointed out 
the symptoms which characterize the first variety of extra- 
vasation.* That which indicates the second, is a painful 
point, deep in the temporal fossa, where the collection of 
blood exists. The patient is disposed to lie on that side of 
the head rather than on the other. 

Cases of steatoma and exostosis are much more obscure; 
the palsy comes on only by degrees, and it is not till after 
death that we can develope the cause of the disease. 

Worms in the stomach are said by some to give rise to this 
form of deafness. The diagnostic criteria will here be of 
great assistance. If the patient has suffered no blow upon 
the head; if he has not fallen upon that part; if there has 
occurred no suppression of any humour whatsoever, if there 
are present any symptoms which indicate the presence of 
worms; if, besides a want of appetite and a foul mouth, there 
occurs the discharge of one or more worms, either by the 
mouth or by stool, and after their discharge the patient hears 

* See chap, ir, of the second section. 
24 



186 

better, there is strong presumption that there exist worms 
which cause the deafness. 

The causes of paralysis of which we have spoken act, 
some mechanically) as the extravasation of Wood, steatoma 
and exostosis; others sympathetically, as do worms in the 
primae viae. Adynamic and ataxic fevers affect the acoustic 
nerve in such a manner that the most practised eye cjan 
scarcely discover the traces of lesion, on making port-mortem 
examination. 

From these different causes there arise two species of 
paralysis, the one with excess, the other with deficiency of 
irritability, or to use the phraseology of Brown, the palsy 
may be sthenic or asthenic. 

The symptoms which mark the first variety, according to 
Grapengiesser are the following. "The patient hears better 
when he is addressed in a low tone and near the ear, than 
when he is addressed in a high tone and loud voice; better 
also in a damp season, and better when at rest than when 
exercising. In this case it is to be presumed that the deaf- 
ness, whatever may be its degree, proceeds from a state of 
direct asthenia, that is from debility with excess of irrita- 
bility."* 

According to the same author the following phenomina de- 
note the latter variety of paralysis. 

"The deafness increases or diminishes according to the 
different states of the patient's health and general excitement; 
according to the vicissitudes of the weather, the particular 
hour of the day, &c." 

"The patient hears better when he feels well, and when 
vigorous from a repast, from having taken wine, and after 
exercising agreeably; also better when in good spirits, than 

* Bibliotheque Germanique, t. viii. 



187 

when melancholy; when the season is dry and the barom- 
eter rises, than when the season is moist and the barometer 
sinks." 

"He hears better in the evening, than in the morning after 
sleep — not so well when he has slept profoundly for a long 
time, as when he has passed a disturbed night." 

"Finally, he hears better and more distinctly when in the 
midst even of loud noises, as those of cannon, than when 
silence prevails around him.* I will add that, according to 
Mr. Cooper, when deafness begins to manifest itself, there is 
a diminution of the secretion of wax, which at length be- 
comes completely suppressed as I have witnessed in an indi- 
vidual fifty-eight years of age." 

Another characteristic sign of palsy of the acoustic nerve, 
pointed out by Mr. Cooper, is that the beating of a watch is 
not heard when it is placed between the teeth. I have had 
opportunities to verify this assertion on many subjects, and 
acknowledge the justness of it. 

The following case goes to substantiate the latter assertion 
of M. Grapengiesser. 

£)### fif teen y ears f age, deaf-and-dumb from birth, was 
insensible to the loudest peals of thunder, and to the firing of 
the heaviest pieces of artillery. On the 12th of May, 1812, 
I injected his ear through the eustachian tube. On the 14th 
he heard a buzzing in the right ear, and on the 15th in both 
ears. On using the subsequent injections the buzzing was 
always renewed. On the 20th the patient gave us to under- 
stand that he heard the sound of bells. On the 22d after 
throwing two injections into each ear, there was discharged, 
by the mouth, a piece of concrete matter of the colour and 
consistence of a slough, and of the size of a grain of buck- 

* Ouvrage cite. 






188 

wheat * This substance issued from the left ear. Afterwards 
there issued from the same ear small black pieces like tobacco, 
coarsely powdered. On the 25th, the patient heard the sound 
of a small bell, and early in June he heard the bell of a 
repeating watch placed at the distance of six inches from the 
porch of the ear. He also heard words uttered with a loud 
voice, such as tabac, pain, vin, papa. To the first word 
he responded a....ba; to the second ba....in, to the third vau, 
and to the fourth ba....ba. 

He also heard the sound of a flageolet, and it appeared to 
affect him disagreeably, for he closed his ears with his hands 
and began to laugh. 

There still remained in the acoustic nerve a considerable 
degree of insensibility, or that which Brown terms indirect 
asthenia; for the patient heard better when the atmosphere 
was dry, and when the north wind prevailed, than when there 
was rain or a storm. He heard better while exercising, than 
immediately after having slept. 

I doubt not that I should have been completely successful, 
had the treatment been continued; but the parents fearing 
that if he perfectly recovered his hearing he would become 
subject to the conscription, opposed the continuance of the 
means which I proposed to employ. The following case 
which I report confirms me in my opinion. 

The son of M. B. book-keeper of this city, twenty-one 
years of age, deaf-and-dumb from birth, aided by an uncom- 
mon degree of intelligence, learned to read, write, speak, 
and understand all that was said to him, merely by observing 
the motions of the lips. The teacher who instructed him 
was ignorant of the ingenious method of L' Epee and Sicard. 

* Perhaps it might be supposed that this was merely a morsal of food 
detached from between the teeth, but all doubt will be removed when it is 
asserted that the mouth was directed to be washed before the injection of 
the ear. 



189 

Young B. scarcely heard the sound of cannon or thunder, 
and when any one spoke to him in a very loud voice, and 
close to the ear, he heard merely a confused noise. With the 
left ear he experienced not the slightest sensation. 

Such as I have just described was the condition of the 
young man when the parents committed him to my care. I 
first examined the internal ear and then the fauces, and found 
both to be in their natural condition. Pursuing my researches 
with reference to the eustachian tube and the internal ear, I 
directed a canula into the right nostril. I entered the tube, 
without producing pain, and threw in an injection of warm 
water. The liquid entered, with facility, the cavity of the 
tympanum and the mastoid cells. 

By this experiment I became convinced that the cause of 
deafness was not in these parts. It occurred to me that it 
must be owing to some defect in the labyrinth, or to palsy of 
the auditory nerves. 

With this belief I deemed it proper to bathe the interior of 
the ear by means of injections. The water of Balaruc, warm- 
ed to from the 20th to the 25th degree of Reaumur's ther- 
mometer, was the liquid which I employed. 

For eighteen successive days the injections were continued 
without any apparent success; but in the night of the 18th or 
19th day my patient, all at once, heard the human voice. 
The next day he gave me to understand that, being asleep, he 
had been waked suddenly by persons who, with cries of joy, 
celebrated the safe arrival of the Duchess of Orleans, and 
made the air ring by repeating a thousand times the cry of 
vive le Roil vivent les Bourbons! 

From that moment the organ of hearing continued every day 
to improve. On the 17th day of the treatment the patient 
heard very distinctly when any one, without closely approach- 
ing, spoke to him in an ordinary tone of voice; but he distin- 



190 

guished belter the deep tones of the male than the higher tones 
of the female voice. Grave sounds were heard more distinctly 
than acute ones. The sound of musical instruments was ani- 
mating and agreeable to him: He distinguished the airs and 
endeavoured to catch the measure. 

The prognosis to be pronounced in regard to palsy of the 
acoustic nerve is difficult in proportion as the causes which 
give rise to it are obscure. That, for instance, which depends 
upon sanguineous congestion, consisting either in extravasation, 
or repletion of the vessels which surround the acoustic nerve, 
is susceptible of cure. 

It is incurable when it depends upon the existence of a stea- 
tomatous, or fungous tumour, or an exostosis. 

Palsy occasioned by the presence of worms in the first pas- 
sage is susceptible of the most prompt and certain cure. 

That variety which occurs in the progress of an adynamic 
or ataxic fever is difficult of cure; nevertheless, we may often 
treat it with some degree of success. 

Treatment. — This should vary in correspondence with the 
causes which may have produced the disease. If the latter 
has been caused by sanguineous congestion, we should have re- 
course to blood-letting, repeated according to circumstances; 
to blisters between the shoulders, and to pediluvia charged 
with mustard. If the congestion has arisen from an attack of 
apoplexy, we should employ the same means, together with 
remedies calculated to relieve the head, applied externally and 
given internally. After these means, whether they may have 
had little or no success, injections should be employed as we 
have already advised. 

Pierre Castro, first physician to the Duke of Mantua, em- 
ployed an ingenious mode of treatment which appears to have 
been successful. After having purged with hellebore, agaric 
or syrup of cuscuta, he shaved the head of the deaf-mute, 



191 

along the coronal suture; he then anointed it, with a liniment 
composed of eau-de-vie, nitre, oil of sweet almonds and the in- 
fusion of water-lilies. He directed the ears and the nose to 
be well cleansed, and the back part of the head to be combed, 
and caused the patient to chew a paste composed of liquorice, 
mastich, ambre and musk. Then some one spoke loudly to 
the patient, with the mouth over the coronal region, and thus 
succeeded in rendering the deaf person sensible to various 
sounds. 

Shower-baths to the head might in certain cases be employ- 
ed with great advantage as is proved by the following case. 

A man became suddenly deaf-and-dumb, in consequence of 
an apoplexy caused by the imprudent suppression of old ulcers 
of the legs. After having employed in vain the ordinary re- 
medies for apoplexy, thirty-two leeches were applied to the 
head, and the patient suddenly revived; but he remained deaf- 
and-dumb. He could move the tongue, and taste food; but he 
could not speak nor utter the least sound of the voice. After 
the ineffectual use of many articles, the author of the case em- 
ployed showering. He chose a solution of sal ammoniac and 
boule de mars, (a preparation of iron and potash,) and let it 
fall from a considerable height upon the top of the head. As 
soon as the first drops had struck the head, the patient experi- 
enced a shock of the whole body. Upon repeating^ the fifth 
time he became pale, and at the sixth he fell senseless upon 
the earth. After careful attention for half an hour, he revived, 
appeared very cheerful, slept tranquilly, and during sleep per- 
spired freely. The showering was repeated on the third day; 
the same phenomina were observed, and the patient fell into a 
profound sleep, the perspiration collected in large drops on the 
whole surface of the body, and on his reviving he recovered 
the power o»ai« , -^h and of hearing. From that moment he 
was perfo no further attempt was made to heal 



192 

the ulcers on the legs, Which had broke out anew from the use 
of vesicatories during the apoplectic attack * 

Deafness often results from blows and falls on the head* 
Instances of it have already been given; but I have elsewhere 
remarked that this variety of deafness is sometimes cured 
by the efforts of nature alone. The following case substanti- 
ates it.f 

"In December, 1807, Francois M***, twenty -five years of 
age, was carried home insensible from a dock-yard, where he 
had been at work. This man while bearing upon his right 
shoulder one end of a large piece of timber, the other end of 
which was carried by another person, fell; his head struck 
with force upon the stump of a tree, whilst the opposite side 
of the head was pressed up<n by the joist which was placed 
upon his shoulder. The patient discharged blood from the 
left ear, and manifested r .up oms of concussion of the brain. 
Those symptoms slowly uisappeared, and there remained no- 
thing but deafness and • inging in that ear. On the first of 
May following, there o "red stupor, vertigo, pain in the 
head and finally intense le and dilirium. A considerable 
discharge of pus, whi(> ^sueu from the left ear, and which 
soon ceased, dispelled t\ symptoms. Hearing was perfect- 
ly restored." 

In the I(ibliothique de irurgie du JYord^. we find some 
observations on a case of £ 3afness associated with blindness. 
It was the result of a metastasis, (what the nature of the hu- 
mour was we are not informed.) Blood-letting, blisters and 
aperients produced no favourable change. The author of the 
case then gave, four times a day, half a grain of tartar emetic, 

* Bibliotheque de Chirurg. du Nord. 

f This case was communicated to me by M. Perreymoweocdistinguished 
physician of the. city of Lorgues, department oy^J f flje <j ea 
t T. i. 1 re. partie. 



193 

together with six grains of gum ammoniac, and increased the 
dose to such a degree as every day to excite vomiting, Be- 
sides this he promoted the alvine discharges, also those of the 
skin and urinary organs. On the twelfth day the patient saw 
a little light; on the twenty-fourth he could discern large ob- 
jects; at length both sight and hearing were restored, but more 
perfectly on the right side than on the left. The author admin- 
istered the same remedies, also with complete success, in ano- 
ther similar case. 

When palsy is caused by a steatomatous or fungous tumour, 
or an exostosis, which is very difficult to be ascertained, we 
should employ only internal remedies, which are calculated to 
resist the cause that may have given rise to the steatoma, 
&c. &c. 

If the disease has been produced by worms in the first pas- 
sages, emetics, purges and anthd ah. . .os will suffice to remove 
the paralysis and to restore hearing. 

Finally, when the disease is a sequel of ataxic or adynamic 
fever, we should first apply bliste between the shoulders, 
then a seton in the neck, and '/ ^ O o. means are insufficient, 
we shold make use of injections ihrowa r into the interior of the 
ear. 

Besides the means of which we e spoken in the course 
of this work, relative to the treatm . of the diseases of the in- 
ternal ear, and the deafness which oJten results from them, it 
remains for us to speak of other remedies which have at vari- 
ous times been recommended. We name them here less for 
the sake of advising their employment than to give a complete 
history of all which has been done in attempting the cure of 
deafness whether congenital, or of accidental occurrence. 

Electricity presents itself first in order, immediately after 
which we shall place galvanism because of its close relation to 
25 



194 

the former. Next we shall speak of mineral and animal mag- 
netism. 

1st. Electricity has been employed as a remedy for human 
diseases for more than sixty years. Europe has rung with 
the reports of the brilliant successes which were said to have 
been achieved by this new agent, especially in Italy. But 
more recent experiments, made in Paris by the abbe Nollet, 
MM. de La Sone, Morand and other skilful physicians and 
learned philosophers, have proved the almost perfect inefli- 
cacy of this agent upon the diseases of the human body* 

The abbe Bertholon, in his work upon the electricity of the 
human body, devotes a long paragraph to the subject of deaf- 
ness. He quotes a great many facts but none from his own 
experience. 

"There have been made," says this author, "many happy 
and successful trials of this agent in deafness, a disease of 
which the principal causes are obstructions in the organ of 
hearing, or an affection of the nerves which are expanded 
there, which obstacles electricity is well calculated to re- 
move."! He afterwards quotes a number of authorities, but 
none of these present a fact which can be regarded as estab- 
ishing the efficacy of this agent. 

Haller, after having subjected one of his patients to the in- 
fluence of electricity during five days, by communicating the 
sparks, and by friction, relieved him a little, but had not pa- 
tience to complete the cure in this manner. 

The following facts, if we may credit them, speak in favour 
of the employment of electricity. 

A lady became deaf in consequence of a milk-engorgement 
of the breast- M. Manduit dispelled it by applying electricity 

* Diet. Encyclop. t. xii. in 4to. au mot electricite. 
t De V f lectricit* du corps hum. t. 1, p. 502 et suir. 



195 

forty-six times. During all this time there was a copius dis- 
charge from the nose, and the urine deposited a viscous and 
fetid sediment. 

M. Manduit also asserts that he has restored hearing to a 
man forty years of age, deaf in the left ear for three years in 
consequence of small-pox, and in the right ear for three years 
in consequence of a malignant fever. This patient was electri- 
fied twenty-four times. There was a viscid discharge from the 
ear* Notwithstanding the confidence which I have in the 
veracity of the author, the second case reported by M. Man- 
duit cannot but cause me to doubt, especially in regard to the 
left ear. The results of seven cases which follow this leave 
me still in doubt. 

M. Comusf states that he has cured two deaf persons who 
had become so by accidental disease. He asserts that on elec- 
trifying them, by insulation, they heard as well as if they had 
not been deaf; that they retained the faculty of hearing, the 
one many hours and the other many days after the experiment. 
The same author declares that the faculty was less when they 
were no longer insolated, and continued gradually to diminish 
till it no longer existed. 

We learn from the cases stated by M. Comus, that the good 
effects of electricity upon the organ of hearing are not perma- 
nent, and that the patient presently relapses into his former 
State. 

In the Journal de Medicine for November 1787, article 
Departement des hopitaux civils, we find cases of deafness 
treated with electricity by M. M. Poma and Rainaud. 

"Of four patients," say the authors of these cases, "the 
two first appeared to derive some benefit from electricity; but 

* Mem. de la Sociele de Med. an nee 1773. 
t Journal de Physique, annee 17 75, 



196 

their cure may have been pronounced very doubtful. lit 
regard to the third there was no ground for hope. The 
fourth appeared to be susceptible of very great benefit from 
the employment of electricity; at least so far as we may 
judge from the different experiments which have been already 
made upon analagous cases, and particularly those of M. 
Manduit." 

The editors of the journal from which we derive these 
facts make the following reflexions. 

"The experiments of M. M. Poma and Rainaud upon deaf 
patients were not successful. The reasons which they give 
for their being unattended with success are founded upon the 
supposed defect of the organ and want of perseverance in the 
employment of the remedy."* 

What was ascertained by M. M. Poma and Rainaud, to 
convince us that their want of success arose from defect of 
the organ of hearing, rather than from the inefficacy of the 
means which they employed? Certainly nothing. 

Since so many physicians have spoken of the employment 
of electricity in cases of deafness, both accidental and con- 
genital, it is matter of surprise to hear M. Lebouvier-Desmor- 
tiers assert that this remedy, as applicable to congenital deaf- 
ness, was discovered by himself: 

"Those" says he "who, till now, have attempted the cure 
of congenital deafness, have supposed the disease to be caused 
by inspissated humours in the cavities of the ear and adjacent 
parts. They therefore employed the remedies best adapted 
to break up, dissolve, and evacuate the substances which dis- 
turbed or impeded the functions of the organ. Local bleed- 
ings, bitter infusions, purgatives, blisters, fumigations, injec- 
tions — all have been employed, but none of them have sue- 

* Journal de Med, Nov, 1787, 



197 

ceeded. I could entertain no hope, therefore, in regard to 
the employment of the same remedies. It seemed to me 
necessary to renounce every attempt, or to seek from some 
less common source, the remedy of which I stood in need. 
Shall I declare that I have discovered it? This assertion 
would be too bold, but I may at least assert that it produced 
such happy effects as to induce us to place confidence in its 
remedial powers. This agent is electricity. "* 

The effects of which he speaks are but of trifling import- 
ance. M. Lebouvier-Desmortiers treated but one deaf-mute, 
fifteen years of age. The treatment occupied six months, 
which the author divides into two epochs, the first from the 
22d of December (year 7 of the Republic) to the 4th of April 
following, during which time he employed vapour baths and 
injections into the auditory meatus. 

The second period began on the 4th of April, and continued 
to the 30th of June, during which he employed injections and 
electricity. He electrified the patient every day, most com- 
monly twice and often three times. 

M. Lebouvier-Desmortiers remarks that the patient heard a 
little with the left ear when addressed in a high tone, with a 
hearing trumpet placed upon the auditory meatus; that the 
right ear was impermeable to sounds; that the patient could 
not hear by the mouth the beating of a watch, the case of 
which was placed between the teeth. 

During the three months of the employment of electricity 
the following effects were produced: 

1st. The patient heard the words papa and mania, and 
counted with her fingers the number of syllables. 

2d. She heard the sound of a pair of tongs when gently 
struck, 

* Considerations on congenital deaf-mutes, p. 135. 



198 

3d. She heard the beating of a watch in the mouth. 

4th. She heard with both ears by means of a hearing 
trumpet, even when addressed in a low tone. 

5th. Finally, she heard the human voice, near the ear, 
through her cap. 

The slight success which M. Lebouvier-Desmortiers speaks 
of so emphatically was not permanent, for, "six months after the 
treatment," says the author, "I went to see Maurice (this was 
the name of the patient) to ascertain the condition of the ears. 
I found her almost as deaf as on the day when I commenced 
the treatment, yet her recent deafness was an incontestible 
proof of the efficacy of the remedies upon the former."* 
This assertion appears to me to be very bold, to say nothing 
more. 

That which M. Lesbouvier-Desmortiers regards as a recent 
deafness, was nothing but the return of the former disease to 
its ordinary state, in consequence of withholding the influence 
of electricity from the nervous system, particularly the acous- 
tic and fifth pair of nerves. It appears to me that the relapse 
of M. L. D's patient, instead of confirming the efficacy of 
electricity in such a case, as this writer asserts, proves, on the 
contrary, that it is both transitory and inefficacious. 

From the trials which have been made with electricity, 
both in congenital and in accidental cases of deafness, we are 
authorized to draw the following conclusions. 

1st. Electricity is a remedy of but little efficacy, and in 
most instances its good effects are transitory and illusory. 

2d. This remedy might be attended with some degree of 
success in partial palsy of the acoustic nerves. 

3d. It will be useless in case of obstruction of the eusta- 
chian tube, the cavity of the tympanum and the mastoid cells. 

* Ouvrage cite 



199 

4th. It is a dangerous remedy when applied to very irritable 
subjects; also to those who are subject to vertigo, epistaxis, 
cerebral congestions, pains in the head, &c. &c. 

II. To Electricity galvanism succeeded; the domestic and 
foreign journals proclaimed its pretended marvellous achieve- 
ments. It has been employed in all diseases which affect the 
human species, and particularly in deafness. 

M. Grapengiesser, of Berlin, appears to have made galvan- 
ism, as applied to medicine, his particular study. He thinks 
that it may be employed with success in the following dis- 
eases. 

1st. Palsy of the inferior extremities. 

2d. Weakness of sight, and gutta serena. 

3d. Partial or complete deafness. 

I shall not here investigate its utility in the two first classes, 
but shall direct my attention merely to the latter, in which 
the author believes that galvanism is applicable merely to 
debility or palsy of the acoustic nerve, with suppression or 
diminution of irritability, whatever may be the degree of the 
affection; "for it is very proper," say MM. Brower and La 
Roche, "to make trial of galvanism in cases in which hearing 
is but in a degree impaired, if we are assured that the deaf- 
ness proceeds merely from indirect asthenia."* 

The symptoms which distinguish palsy with excess of irri- 
tability, from that characterized by defect of it, have been 
described at the commencement of this section. M. G. does 
not recommend galvanism in direct asthenia with excess of 
irritability. In this form it has never been successful. 

Of nine cases of deafness, more or less complete, reported 
by M. G. there are three of congenital disease. The subject 
of the first case was a child of twelve years. The author 

* Biblioth. Germ, medico-chirurgicale, t. viii. 



does not state the number of times that he subjected the 
patient, to the influence of galvanism. He merely states that 
by the continued employment of the remedy he acquired the 
faculty of hearing in one ear to the degree that "he was able 
to repeat, word-for-word, what was spoken in a low voice 
behind him, to any person near, which words, however, he 
could not articulate correctly."* 

He was but partially successful in the two other subjects, 
one of the age of five years and the other of six. M. G. 
ascribes this to the discontinuance of the treatment in conse- 
quence of the resistance made by the little patients. 

Of the other six cases, the treatment of one was unsuccessful, 
and in the remainder the success was not triumphant in favour of 
galvanism, because it was employed in association with other 
remedies. 

The medical journals of Paris also make mention of cures 
accomplished by galvanism in various cases of deafness. 

I know not what degree of credence we ought to give to all 
these cases; for myself, I frankly declare that I have employed 
galvanism for various affections, especially deafness, both 
accidental and congenital, and that my attempts have been 
unsuccessful. Further, this agent in the case of Cartenon, 
(which I have given in the second section) was injurious. It 
brought back the buzzing sounds in the right ear and hearing 
become more obtuse. 

The opinion of M. Rinauld concurs with that which I have 
just given. "According to him," says M. Sue, "if we appeal 
to those trials which have heretofore been made upon the 
organ of hearing, it is ascertained that the organ is not suscept- 
ible of any immediate influence from this agent, "f 

* Ouvrage cite. 

| Histoire du Galranisme, 1 er. partie, p. 159, et 160, 



201 

Galvanism is injurious and even dangerous, when the patient 
is subject to pains in the head and to congestions of blood in 
that part. It will be of no avail when there are obstructions 
in the eustachian tube, the cavity of the tympanum, or the 
mastoid cells. Finally, the remedy is so painful that few 
persons can endure its application. 

III. Mineral magnetism is said to have been employed with 
success, by Mr. Klarick, physician to the King of England, in 
a case of incomplete deafness with buzzing. He employed it 
for three months, three times a day, and for several minutes 
each time.* 

This agent appears to me to be a very feeble remedy for 
disease; it is true that it has been employed with some appear- 
ance of success in rheumatic pains located in the teeth, and 
other parts of the body. It is asserted that it dispelled the pain 
as soon as it was applied to the painful part; but the pain returned 
with the same intensity as soon as the magnetic apparatus was 
removed. It is manifest, then, that the remedy is ineffica- 
cious, since it merely suspended the effect without removing 
the cause. Besides, to what cases of deafness could this 
remedy be applicable? It is asserted that it was successful in 
incomplete deafness, but what was the cause of this deafness 
we are not informed. It appears to me that no advantage 
could be derived from its employment, except in case oi 
spasm of the auditory nerve. Nevertheless, I must confess 
that I am in possession of no fact which would authorize 
me to employ the remedy exclusively of other means. 

IV. M. Hagstroem has employed, without success, animal 
magnetism, upon a man who appeared to be of a constitution 
proper for the observation of the effects which the agent 
might produce. The magnetic apparatus was applied regu- 

* Journal economique, Janvier 1767. 

26 



202 

larly for three months. On being interrogated in regard to 
the sensations which he experienced he answered, always by 
signs, that he perceived no effect or relief, either in his ears 
or the rest of his body. 

The public, I am persuaded, are out of conceit with the 
impositions of Mesmer, and are undeceived in regard to the 
numerous good effects of this pretended catholicon which is 
aow falling into neglect. Nevertheless, it appears that new 
efforts have been made to revive it. Whether the works of 
MM. de Puy-Segur and Deleuse, will accomplish this I am 
disposed to doubt. 

V. It has been remarked, says Leschevin, that the external 
ear receives many rays of sound and reflects them toward the 
auditory meatus, and it is observed that this mechanism con- 
siderably increases the sensation. On this principle, (which 
is proved by observation of those whose ears are badly 
formed, or removed by accident, and who, in consequence, 
hear less perfectly) various acoustic instruments have been 
constructed, all of which have a large opening to admit the 
undulations, and a small one which is introduced into the ear 
and in which they all meet as in a focus. The more simple, 
the more useful are they, and perhaps the best of all these 
instruments is a curved conical tube in the form of a horn.* 

It is unnecessary that we should dwell longer upon this 
subject; the various forms with descriptions of these acoustic 
instruments may be seen in many works on surgery, and par- 
ticularly in the Dictionary of the Medical Sciences. 

* Journal de Medecine, ann«e 1793. 






CONCLUSION. 



It is manifest, from all which, has heen stated in this work, 
that deafness may arise from various causes, and that its 
treatment should correspond to the cause which may have 
produced it. 

I have pointed out with as much precision as I could, the 
diseases of the internal ear from which deafness arises; I have 
explained their diagnosis, their causes, their symptoms, and the 
means of cure. I have also designated those which are 
irremediable. I have suggested some improvements of Coop- 
er's mode of operating, and have invented instruments proper 
for probing and injecting the eustachian tube through the nasal 



Such is the result of my reseaches, of my reflections, and 
my practice. May my efforts be acceptable to the profession, 
to whom they are submitted! If so, I shall be assured that 
they are useful to mankind. 



SUPPLEMENT 



DISEASES OF THE EXTERNAL EAR, 



BY THE TRANSLATOR OP THE FOREGOING ESSAY. 



The diseases of the external ear, being obvious to the eye, 
and accessible io the hand of the surgeon, are recognised 
with far more ease, and treated with much more precision 
and success than those which affect the deep-seated parts of 
the apparatus of hearing. They are also less important, in 
as much as they do not so often impair the function of this 
valuable sense, and yet they are not uninteresting in this 
respect, as they sometimes extend to the more essential 
organs, or are the effects and symptoms of more deeply seated 
disease. 

All the parts of a complicated apparatus are intimately 
associated with each other by nervous sympathy. In their 
vital qualities they must be identified with each other, in order 
that they may co-operate in their functions. Their morbid 
associations must necessarily be equally intimate. When, for 
instance, from any cause inflammation occurs in the external 
appendages of the eye, there immediately takes place a mor- 
bid sensibility in the interior of that organ and the eye 
becomes intolerant of light. Did the cause persist, it is 



206 
obvious that permanent disease would result in the interior 
apparatus. This sympathy is owing to the vital correspond- 
ence which, in health and disease, is perpetually going on 
between the eye and its appendages, through the branches of 
the fifth pair of nerves. 

The same vital intercourse, though less demonstrable, exists 
between the external and the internal ear. Certainly, then, the 
diseases of the former are important, not only because they 
are in themselves disgusting and troublesome, but because they 
are often the precursors of more serious disease. 



Wounds of the external ear. 

A word in regard to the treatment of these injuries is all 
that will here be required. Whether the wound be incised, 
lacerated, punctured, or contused, the object of the surgeon 
should be to preserve the form and integrity of the organ. 
This will be best accomplished by the most simple means. 
When the separation of parts is extensive, it is first necessary 
to bring them nicely in opposition and to maintain them thus. 
The peculiar form of the organ requires the mode of dressing 
to be something different from that which is elsewhere em- 
ployed. The interrupted suture will be needed and should 
be passed merely through the integuments of the organ. In 
extensive cuts it may be necessary, for more perfect security, 
to apply stitches on both sides of the organ. Adhesive straps 
should then be nicely adapted to the parts, and the wound be 
covered with pledgets of fine lint, which will adhere by the 
drying of the blood that oozes from the wound. 

We are advised by most surgeons* to cover the ear with a 

* Dictionnaire dea Sciences Medicales, torn, xxxvii. Article Oreille 



201 

bandage passed round the head, the ear being protected from 
unequal pressure and displacement by bolsters of lint or 
cotton placed around its margin. I can discover, however, 
no utility in the employment of a bandage; the adhesive straps 
and the loose lint will be sufficient to protect the organ from 
the atmosphere, unless the season be inclement, and then a 
loose elastic cap may be used, the ear being protected by 
compresses placed before and behind it. 

We need never despair of effecting re-union unless the 
organ be completely dissevered. Although there may be but 
the slightest attachment, the vitality of the parts and the integ- 
rity of the organ, may often be preserved. 

Should the violence inflicted upon the ear be so great as to 
threaten it with gangrene, means should be employed for the 
purpose of preventing such a result. If violent inflammation 
be the first effect, we should endeavour to assuage it by the 
usual antiphlogistic means. Should gangrene manifest itself, 
no better local application can be employed, to arrest its 
extension, than the fermenting cataplasm, which is both anti- 
septic and stimulant. 

I have said nothing of hemorrhage from wounds of the ear 
because the arteries of the organ are so minute as that they 
almost always spontaneously cease to bleed when divided. 
Sometimes they may require the ligature. 



Ulceration and sloughing of the external ear from pressure. 

When an individual, in consequence of severe and pro- 
tracted disease, is for a long time confined to his bed, and, on 
account of local pain, is compelled to repose constantly upon 
one side, the ear, by the continued pressure even of the softest 
pillow, becomes affected sometimes with ulceration and some- 



208 

times with sloughing. This the more readily takes place 
because of the languid state of the circulation in such cases, 
and the inability of the capillaries to resist such injury. In 
phthisis this injury frequently results from the patient being 
often compelled to lie constantly upon one side. 

Of course the first object of the physician should be to 
obviate the cause, and this is accomplished by the employment 
of a quilted pillow which has a hole in its centre correspond- 
ing to the ear. Simple dressings should be applied to the 
ulcer. 



Mal-position of the external ear. 

Although the external ear, in man, is by no means so impor- 
tant a part of the acoustic apparatus as it is in some other 
animals, it cannot be doubted that its peculiar form is designed 
to favour the reflection of the undulations of the air, in such a 
manner as to concentrate them upon the membrana tympani. 
This end will certainly be defeated whenever, from any cause, 
the ear acquires an unnatural attitude in regard to the head. — 
Mal-position of the ear also produces an unseemly appearance, 
which, of itself, is sufficient to induce us, if possible, to cor- 
rect the evil. 

Mal-position of the ear almost always results from some 
unfortunate habit of wearing the hat or head-dress. Boys 
often wear the hat so low upon the head as either to push the 
ear outward, and to cause it project from the head, or to 
compress it against the head and cause it to assume too close 
a position. The latter often occurs in females, from confining 
the ear too closely with the head-dress. 

To remove the deformity it is only necessary to correct the 
habit. 



209 

It may be well to remark here, that other evils sometimes re- 
sult from improperly covering the ear with head-dresses, caps, 
&c. Nature evidently designed that the ear should be expos- 
ed, that the atmosphere should at all times have free access to 
the membrana tympani, and that the air contained in the mea- 
tus should be frequently changed. If the external orifice of 
this canal be too closely covered, the air stagnates in the cavi- 
ty, the exhalations are confined, and the organ acquires a 
morbid sensibility. Each of these circumstances favours the 
occurrence of ulceration. The practice of stuffing the ears 
with cotton, is obviously still more injurious. 



Imperforate condition of the external meatus. 

This imperfection is generally congenital. Most frequently 
it is associated with some irremediable defect of both the ex- 
ternal and the internal ear which precludes all surgical means. 
Yet, sometimes there exists a mere continuity of the external 
integuments over the orifice of the meatus. In such a case we 
may readily ascertain that the internal ear is perfect, by the fact, 
that the individual hears with that ear though indistinctly, and 
that the beat of a watch held in the teeth is distinctly heard; 
also from the fact that air may be forced into the tympanum. 

If the obstruction yield to pressure, we may infer that it is 
membranous, I then should not hesitate to puncture it with a 
lancet, and to introduce a piece of bougie for the purpose of 
preserving the opening. Or the septum might be cut away 
with an instrument like an iris-knife. Caustic might be prefer- 
able in some cases* 

*Since the above was written I have been consulted in regard to the pro- 
priety of attempting euch an operation on an interesting little patient in this 
city. The child is now three years of age. He was born with imperforate 

27 



210 

Were the passages of both ears firmly closed we might ha- 
zard the deep introduction of an instrument, for the important 
purpose of restoring the function of these organs. It should be 
conveyed in the direction of the meatus and almost to the sup- 
posed seat of the tympanum. There would be no danger of 
wounding any important organ. 

Sometimes the external meatus is obstructed by the mal-po- 
sition and unusual size of the tragus, this cartilage lying 
obliquely over its orifice. In such a case Monfalcon * recom- 
mends to obviate the evil by introducing into the meatus a 
small hollow cylinder of silver which will keep the orifice 
open and press forward the tragus. 

"M. Boyer has pointed out a species of mal-formation of the 
external meatus worthy of notice, in which the canal is flat- 
tened and the opposite walls pressed into contact with each 
other for some extent. He was consulted by an individual 
who had been rendered almost perfectly deaf by this defor- 
mity. He constructed a gold canula, of the form and diame- 
ter of the meatus, expanded at its external orifice; this he in- 
troduced into the meatus, and the patient, who constantly wore 
it, from that time continued to hear perfectly." 

meatus on one side, and with mal-formation and partial deficiency of the 
external ear. It presents, indeed, the appearance of a mere rudiment of 
the perfect organ, and disfigures that side of the head. 

In place of the orifice of the meatus there is a small fossa, aud just before 
it a small vestige of the tragus; but when I seize the lobe of the ear and 
draw it outward, this fossa follows, and we discover that it has no connec- 
tion with any cartilaginous or bony canal. I can feel, indeed, by pressing 
the finger firmly into the fossa, the extremity of a cartilaginous body point- 
ing outward, but it seems to have no hollow. 

I am persuaded that in this case, the internal ear is equally amorphous, 
and consequently that no operation would be of any avail. 

The external ear of the opposite side is larger than usual, and the func- 
tion of the organ unusually perfect. 

*Dictionnaire des Sciences Me"dicales, torn, xxxviii- Article Oreielle. 



211 



Foreign bodies in the meatus externus. 

Nature has certainly formed the external orifice of the mea- 
tus very admirably for the purpose of preventing the ingress 
of foreign bodies and insects. They cannot have direct ac- 
cess to it in consequence of its obliquity and the protection 
which it receives from the tragus. The concha, so well de- 
vised for the purpose of throwing the undulations of air into 
the ear, reflects from it all other bodies. The orifice of "the 
meatus is also fortified by a sort of palisade of small hairs, 
pointing outward. The secretions of the cavity, being bitter 
and offensive, deter insects from nestling there. 

Notwithstanding these defences, small bodies are sometimes 
pushed into the meatus, and getting wedged there, cause great 
irritation and consequent mischief. An alarming inflammation 
sometimes occurs and is propagated to deep-seated parts; ul- 
ceration takes place in contact with the body and morbid gra- 
nulations are formed around it. Thus the meatus will be com- 
pletely closed, and hearing greatly impaired. 

These bodies are most apt* to be the toys of children, such 
as glass beads, shot, cherry stones, kernels of grain, &c. &c. 
When those bodies which are hard, round, and smooth, are 
forced deep into the meatus, it is sometimes a matter of ex- 
treme difficulty to remove them, because, from their form and 
smoothness, they elude the grasp of forceps and other instru- 
ments used to extract them, and are forced still more deeply 
into the ear. 

Kernels of grain, by absorbing the moisture of the passage, 
become greatly swollen, distend the passage and for a time 
give much inconvenience; but as they become soft and decay, 
they are at length removed without difficulty, or are spontane- 
ously discharged. 

The removal of hard spherical bodies should be attempted 



212 

with the utmost caution, lest they be thrust inward so far as 
even to rupture the membrana, and enter the tympanum. A 
substance of this kind should never be forcibly seized with 
the common forceps, the blades of which cannot be insinuated 
between the meatus and the body. They will certainly slip 
from it, and thrust it more deeply in. The best instrument 
which I have used for this purpose is a steel stylet which ta- 
pers from one extremity to the other, in order that the extre- 
mity held in the fingers may be sufficiently inflexible to be 
used as a handle. The other extremity has the size of a very 
small probe, is obtuse, flattened laterally, and bent at the point. 
This point is to be insinuated beyond the foreign body, and the 
instrument used as a lever to disengage it. 

Where this is insufficient I would employ forceps with long 
slender blades, bent nearly at right angles about an inch from 
their points, which should be thin, a little convex on the 
out side, and slightly curved inward. They are bent, that the 
hand of the operator need not exclude the light. The modi 
of using them is obvious. This instrument will resemble that 
of Lamotte, which was shaped like the beak of a woodcock. 

Some have recommended that an incision be made in the 
cartilage of the meatus in order to obtain more room for the 
extraction of the body. In ordinary cases I cannot conceive 
how any advantage could be derived from such an operation. 
However, the cartilaginous opening may sometimes be unusu- 
ally contracted, and were I to experience much inconvenience 
from it, in the use of the instrument, I would incise it obliquely 
upward and outward. 

Sometimes the foreign body may be cut to pieces with a 
couching needle and thus removed, as was done by Professor 
Gibson. 

When the substance has been removed the ear should be 



213 

xleterged by an injection of warm milk and water, and if there 
be inflammation leeches should be employed, &c. &c. 

I should here remark that we ought never to confide in the 
conviction of the patient that there is a foreign body in the 
ear. Before introducing any instrument we should examine 
the meatus with great care. Not long since, a young woman 
called upon me to remove a pin supposed to be lodged in the 
ear. A small shining body was seen deep in the meatus which 
was supposed to be the pin's head and many attempts had 
been already made to seize and remove it. Although these 
attempts had been made with skill and caution, some irritation 
and swelling were produced. On examining the ear with 
great care, in a manner hereafter to be described, I became 
convinced that there was no offending substance in the ear, 
and that the supposed head of the pin was merely a drop of 
semi-fluid substance adhering to the tympanum and reflecting 
the light in a peculiar manner. 



Indurated wax in the meatus. 

A morbid state of the secretions of the meatus is very apt to 
be associated with a diseased condition of the internal ear, but 
sometimes the accumulation of hardened wax in the ear, is the 
sole cause of a considerable degree of deafness. In either case 
it is very important that its presence be ascertained, and that 
it be removed. 

We ascertain its presence by inspection, which is best ac- 
complished by placing the head in such an attitude as to suffer 
the sun's rays to enter the meatus and impinge upon the tym- 
panum. To effect this, the operator must seize the external 
ear, and drawing it outward from the head, extend and 
straighten the cartilaginous part of the meatus. I have been 



214 

able to inspect the ear more perfectly by introducing, at the 
same moment, a steel director, with its groove toward the 
meatus and its convex side pressed firmly against the anterior 
walls. The passage is thereby both straightened and ex- 
panded. 

If there be no wax present the tympanum will be seen, of a 
pearly white colour and concave. If wax be present the ca- 
vity is less deep than it should be, and its bottom black. 

To remove this muco-ceruminose matter, it is only necessa- 
ry to inject the ear frequently with soap and water, or an al- 
kaline solution. The stream should be thrown in with force 
and many times at each sitting. Sometimes the substance will 
be so impacted in the organ, that it will be necessary to inject 
the ear for many days before it can be dislodged, and to aid 
the removal of it with the probe. Hard cylinders, more than 
half an inch in length, and of the form of the meatus, are 
sometimes thus removed and hearing greatlv improved. 

When the obstructing substance has been removed, it will 
be necessary to make use of some stimulating lotion which 
shall excite the membrane to the healthy exercise of its func- 
tions. For this purpose the infusion of cloves or cinnamon 
may be employed; also the water of ammonia much diluted. 



Insects in the meatus. 

Insects sometimes nestle in the external meatus, notwith- 
standing the pains which nature has taken to make it an un- 
comfortable dwelling for them. Sometimes a mischievous fly 
deposits her eggs there which soon become larvae and pro- 
duce intolerable pain, itching, and noise in the ear. I knew 
aia old gentleman in Vermont into whose ear, while he was 
sleeping in his orchard, "his custom always of the afternoon," 



215 

not the "juice of cursed hebenon," but the eggs of an insect 
were dropped. The next day they became maggots, and 
"then began the tempest in his head." They occasioned such 
an intolerable sensation and he flounced about in such a man- 
ner that it was almost impossible to keep him still while there 
was dropped into the ear a small quantity of brandy, which 
effectually quieted the marauders. 

In another instance I knew a honey-bee to fly directly into 
the meatus. Finding it not to be a nectary he struggled to 
escape, and in so doing scratched the tympanum with his 
claws. This produced a perception of sounds louder than 
peals of thunder, together with excruciating pain. The suf- 
ferer flung about like one distracted, and exclaimed so incohe- 
rently that nobody could tell what calamity had befallen him, 
till the bee fortunately escaped. 

Insects in the ear are promptly destroyed by pouring into 
the meatus whiskey, brandy, oil, or the infusion of tobacco. 
The most effectual remedy, if at hand, would be the tincture 
of camphor. 

Inflammation produced by insects in the ear is to be treated 
precisely as that which arises from any other cause. 



Polypus excresences in the meatus. 

The author of the foregoing work has treated of polypus 
adherent to the tympanum. His remarks are equally applica- 
ble to that form of this disease in which the excrescence grows 
from the walls of the meatus. Indeed, in most cases, when 
the excrescence is so large as to fill the diameter of the cavity, 
it is impossible to determine where it may be implanted. Did 
we know it to be attached to the sides of the tympanum we 
might, without fear, seize it with forceps and tear it away. 
In all other respects the treatment is the same in both cases. 



216 

I am inclined to believe that true polypus rarely occurs in 
the meatus, and that the excresence, which is often regarded 
as such, is merely a crop of morbid granulations shooting from 
an ulcerated surface. 

If a polypus be attached to the membrana there is certainly 
great danger in tearing it away, lest that organ be lacerated. 
As we cannot generally determine where its attachment may 
be, other means are more safe. The frequently-repeated ap- 
plication of the nitrate of silver, will be found to destroy the 
tumour effectually whatever may be its nature, and at the same 
time to subvert the diseased action that may have given rise to 
it The remedy may be applied in the solid form through a 
canula introduced to protect the meatus; or a solution may 
be applied with a camels-hair pencil. Astringent injections 
should be subsequently employed, to prevent the recurrence 
of the disease. 



Morbid dryness of the meatus. 

Morbid dryness of the meatus is almost always the result 
of constitutional disease. The same morbid state of the capil- 
lary system which produces an arid skin, and scanty secre- 
tions of all the emunctories, may also produce a diminished se- 
cretion of mucus and wax in the ear. This dryness also exists 
in the tympanum, and there seriously impedes the function of 
hearing. There is also, almost always, co-existent with this 
dryness of the ear, a degree of insensibility in the acoustic 
nerve. This arises from the same constitutional disorder and 
is immediately dependent probably upon the feeble state of 
the circulation in the minute vessels and defective nutrition 
consequent upon it. 

It is very plain that in this affection the general health 



217 

should first occupy our attention. Means should be employed 
for the purpose of restoring the secretions, and equalizing the 
excitement of the system. This will often be accomplished 
by the employment of purgative medicines, associated with 
mercurial alteratives; well-regulated regimen; the warm bath; 
frictions upon the skin; exercise, &c. &c. 

In aid of these general means, we may inject the ear with 
warm milk and water with which a few drops of the oil of 
rosemary or some other aromatic oil have been blended. The 
oil of almonds may be occasionally dropped into the ear. The 
orifice of the meatus should be closed with cotton, in order to 
preserve the moisture of the organ. 

Soap and water, so commonly used when the secretions are 
redundant would here be injurious. 



Inflammation and abscess of the meatus 

Is characterized by the general symptoms of inflammation, 
extreme pain and diminution of the sense of hearing in conse- 
quence of the partial or complete closure of the meatus and 
the morbid excitement which is imparted to the internal ear. 

General and local bleeding, especially the latter, should be 
promptly and repeatedly employed, together with cold appli- 
cations, purgatives, and indeed the whole apparatus of anti- 
phlogistic means. Should it not be possible to dispel the in- 
flammation, suppuration should be promoted by the applica- 
tion of poultices or fomentations. As soon as there is evi- 
dence, from the abatement of pain, sense of weight, and per- 
haps from fluctuation, that pus is formed, the abscess should 
be immediately punctured if it be judged accessible to the lan- 
cet. Poultices should then be continued and the ear be occa- 
sionally syringed with warm water. Should an ulcer remain, 
28 






218 

after the subsidence of swelling and inflammation, it is to be 
treated as will be hereafter stated. 



Ulcers of the meatus. 

There is no portion of the membranous tissues of the body 
which seem to be so often the seat of local disease, as those 
parts of the tegumentary system which line the orifices of 
canals leading to internal cavities. Here the skin and mucous 
membrane are insensibly blended with each other, the sensi- 
ble properties and vital qualities of the one being in some degree 
lost, and those of the other assumed. Thus, the muco-cuticu- 
lar membrane which invests the lips, that which enters into 
the auditory meatus, that which lines the prepuce, and that 
which is reflected over the verge of the anus, are charac- 
terized by the combined qualities of the skin and mucous 
membranes; they perform the offices of both these tissues, 
and participate in the diseases of both. 

The external and the internal integument, being thus inti- 
mately blended with each other, interchange their morbid 
influences by a continuous sympathy. A morbid state of the 
mucous lining of the stomach diffuses itself along the mem- 
brane till it reaches the skin. The converse of this is true in 
regard to disease primarily seated in the skin. It is obvious 
then that the muco-cutaneous tissues are exposed to morbid 
influences alternately from within and from without. Thejr 
are also often irritated by the acrid matters which occasionally 
issue from the internal cavities or which enter them. 

Another circumstance which pre-disposes these tissues to 
frequent disease is their acute sensitiveness, a kind of elective 
sensibility, which is bestowed upon them for the purpose, in 



219 

some places, of guarding against the ingress of substances 
unfriendly to the powers of life. 

The above, as it appears to me, are satisfactory reasons, 
why the membranes lining the orifices of canals leading to in- 
ternal cavities are more frequently the seats of disease than 
either the skin or the pure mucous tissues. They account for 
the frequent occurrence and obstinate continuance of ulcers of 
the meatus; of the margins of the eyelids; of the lips, the 
prepuce, and the verge of the anus. 

It is in some one of these regions that the system, when 
labouring under a pre-disposition to disease, which Saissy ha9 
so frequently called a morbific humour, seeks an outlet by 
which to relieve itself of diseased action. Nature often 
creates issues there for the purpose of diverting disease from 
more important organs. These ulcers are very often of a 
scrofulous character. 

Ulcers within the meatus are often caused by the lodgment 
of some foreign body in the passage— sometimes they are the 
sequel of abscesses in these canals, arising from any of the 
causes of inflammation. 

The existence of an ulcer within the meatus is easily ascer- 
tained by inspection; also by the discharge which issues; this is 
of a purulent character, but somewhat peculiar. It is more 
sanious than pus ordinarily is in other parts and has an offen- 
sive odour, disagreeable to the patient and those around him. 

If the disease arise from one of the transitory causes which 
I have named, the removal of the cause will interrupt the dis- 
ease. The recuperative powers of the system are always 
sufficient to effect the cure of such ulcers, when there exists 
nothing to defeat their efforts. It is necessary merely to cleanse 
the meatus by injections of milk and water, or water with a 
little alkali, or soap, and to protect it from a cold atmosphere. 

But very frequently there exists a scrofulous^ or some other 



2X) 

morbid diathesis upon which the local disease, once excited, 
is engrafted and thus maintained. When such is the condition 
of the system, ulcers in the meatus may occur without any 
apparent exciting cause, and may be continued for an indefi- 
nite period, till the discharge of pus becomes habitual. 

It is not probable that such a source of irritation can exist, 
even in the appendages of the organ of hearing, without, in a 
greater or less degree, impairing the functions of the organ. — 
Sometimes morbid granulations shoot from the ulcerated sur- 
face and overspread the membrana tympani, excluding the un- 
dalations of the air. In other cases the ulceration slowly pro- 
gresses till the membrana is destroyed, the small bones dislo- 
cated, and at last the acoustic nerves participate in the dis- 
ease. 

Since, then, the disease is always a source of great annoy- 
ance to the patient, almost always in some degree impairs the 
perception of sounds, and may altogether destroy it in the ear 
affected, it is of course very desirable that we should remove 
the disease, provided it can be accomplished without inflicting 
upon the system a greater evil. 

Treatment. — If the disease be one of recent origin, we may 
suppress the discharge with little fear of any evil consequen- 
ces, provided there be not some remote irritation which 
seeks an outlet for its diseased action in the ear. Difficult 
dentition in children is often associated with abscess and sub- 
sequent ulcers in or behind the ears. Irritation in the stomach 
and intestines from the retention of acrid secretions, from nox- 
ious ingesta and worms, often spends its morbid influence in the 
same way. 

It would certainly be imprudent to attempt the healing oj 
such ulcers till the remote sources of mischief are provided 
against. The irritation of dentition being passed, the stomach 
and bowels being evacuated by the use of mercurial cathartics 



and restored to a healthy condition by the continued use ol 
laxatives, alteratives and a judicious diet, we may use our lo- 
cal means without fear. 

These are various medicated injections. First, we should 
employ an alkaline solution, for the purpose of deterging the 
organ, and indeed this should be continued while other means 
are used. The sulphate, or the acetate of zinc, in the pro- 
portion of ten grains to four ounces of water, or other mild 
metallic astringent, may next be used. Should these prove 
ineffectual, some solution which may make a stronger impres- 
sion upon the ulcerated surface, and thus subvert the diseased 
action, will be necessary. For this purpose the muriate of 
mercury may be employed, in the proportion of two grains to 
the ounce; or a solution of the nitrate of silver of the same 
strength. The sulphate of copper will in some cases be found 
more effectual than either. In protracted cases these remedies 
should be used in succession. 

Some surgeons hesitate to attempt the suppression of those 
purulent issues, which may have existed for years in the tympa- 
num. Cases of this description are generally those which will 
be found to have commenced in infancy, during the period of 
teething, and which at that time have engrafted themselves up- 
on a scrofulous diathesis and have become habitual. 

Certainly it would be very imprudent to attempt the healing 
of such an ulcer without creating a diversion in some other 
part, in favour of the sanative powers, and in aid of our reme- 
dies. A diseased state is certainly not the most natural condi- 
tion of the system. A morbid, habitual excretion may have 
taken the place of a healthy one, and may be necessary, be- 
cause of the suppression of the latter, but it certainly cannot 
harmonize equally well with the other functions. If, then, the 
system has capriciously adopted a morbid habit we should sub- 
vert it by re-establishing the healthy one. 



222 

We should commence the treatment of such cases by the 
application of a small blister to the nape of the neck, or to the 
arm, and this by the application of savin ointment should be 
kept discharging for some days. In the mean time the general 
remedies which we have named above should be vigorously 
employed, till we may suppose that an impression has been 
made on the system, and then the local means may be put in 
requisition for the purpose of suppressing the issue. During 
the employment of the latter, and indeed for some time after 
the healing of the ulcer, the blister issue should be continued, 
the surgeon thus leaving open a postern for the enemy to 
escape, and instead of compelling him to a desperate re- 
sistance, allowing him to march off, if he will, with the ho- 
nours of war. 

The reader will have noticed that Saissy, in the foregoing 
Essay, objects to the amplication of blisters behind the ear 
over the mastoid region, and cites cases to show that they 
are extremely liable to influence injuriously the function of 
hearing. 



DESCRIPTION OF AN INSTRUMENT FOR PERFORATING THE 
MEMBRANA TYMPANI. 



Having had occasion in two instances to perforate 
the membrana tympani, and having found the benefi- 
cial effects of the operation soon to cease in conse- 
quence of the speedy closure of the artificial opening, 
I have devised the instrument, represented in the cut, 
for the purpose of removing a circular portion of the 
membrane. 

It is merely a small cylinder of steel, something less 
than a line in diameter, and an inch and a half in 
length from the handle. The extremity is truncated 
and flat at the end, except that there project from op- 
posite parts of the margin, in the direction of the 
shaft, two little points, or blades, each of which has a 
cutting edge, but these edges are on opposite sides. 
The points are three-fourths of a line in length, and 
should be made as delicate as possible. 

It is obvious that when these cutting points are 
thrust through a membrane, and the shaft of the in- 
strument is made to revolve, a circular piece must ne- 
cessarily be cut out. The instrument, as I have as- 
certained by experiment, will, with the greatest fa- 
cility, cut a circular piece from any membranous 

substance — even from paper, which is far more difficult to cut 

than animal membrane. 

In using it I guard it with a piece of a gum-elastic cathetar, 

long enough to extend from the handle to the bases of the 

points, leaving them projecting. This being first introduced, 



224 

so as to touch the membrane at its lower and anterior part, 
the stylet is conveyed into it, made to perforate the membrane, 
and then, being twirled in the fingers of the operator, is made 
to revolve twice or thrice. 

The cutting out of a circular piece of the tympanum obvi- 
ates the necessity of introducing a tent or bougie, as is done 
by Saissy, and which must create much irritation. 



TABLE OF CONTENTS. 



Page. 

Translator's Preface, 5 

Author's Preface, ..-------7 

Biographic notice of Jean Antoine Saissy by M. Montain, - 9 

Introduction, 17 

SECTION FIRST. 
On diseases of the membrana tympani, - - - 27 

Chap. I. On the fungous membrane which covers the membrana 

tympani, ------ . „ _ . og 

Chap. II. On polypous excrescences growing from the external 

face of the membrana tympani, - 32 

Chap. III. On relaxation of the membrana tympani, 34 

Chap. IV. On the sinking or protrusion of the membrana tympani 

in the form of a pouch, toward the cavity of the tympanum 

or the external meatus, ------- 39 

Chap. V. On morbid tension of the membrana tympani, 41 

Chap. VI. On inflammation of the membrana tympani, 42 

Chap. VII. On induration of the membrana tympani, - - - 64 
Chap. VIII. On rupture of the membrana tympani, - - - qq 

SECTION SECOND. 

On the diseases which affect the cavity of the tympanum, 
the mastoid cells, the small boxes of the ear, and 
their muscles, ---__-._ 7q 

Chap. I. On catarrh of the internal ear, - - - - - fr. 

Chap. II. On acute inflammation of the membrane which lines 
the cavity of the tympanum and the mastoid cells, and on 
abscesses and purulent accumulations in those cavities, - &2 

Chap. III. On dropsy of the cavity of the tympanum and mastoid 

cells, 109 1 



227 

Chap. IV. On extravasation of blood into the cavity of the tympa- 
num and mastoid cells, - - * - - - - - 112 

Chap. V. On the accumulation of mucous and ceruminose matters 

in the cavity of the tympanum and the mastoid cells, - - 114 

Chap. VI. On the obstruction of the cavity of the tympanum and 

mastoid cells by chalky substances, - - - - - - 121 

Chap. VII. On diseases which affect the small bones of the ear, 125 

Chap. VIII. On diseases which may effect the muscles attached to 

the small bones of the ear, ------ 127 

Chap. IX. On fuzzing (bourdonnement) of the ears, ... 129 

SECTION THIRD. 

On the diseases of the eustachian tube, - 135 
Chap. I. On the imperforate condition of the internal orifice of the 

eustachian tube and on the obliteration of that canal, - ib. 

Chap. II. On catarrh of the eustachian tube, - 142 

Chap. III. On obstruction of the eustachian tube, - ib. 

SECTION FOURTH. 

On diseases which, by affecting parts in the vacinity of the 
eustachian tube, give rise to deafness and sometimes to 
severe diseases of the internal ear, - 163 

Chap. I. On the inflammatory swelling and abscess of the tonsils 

and palate half-arches, ----._ ^ 

Chat. II. On the catarrhal swelling of the tonsils and the palate 
half-arches, and on the mucous accumulations which cover 
or surround the orifice of the eustachian tube, - 170 

Chap. III. On polypus of the posterior nares, and other bodies 
which compress the eustachian tube, regarded as causes of 
deafness, - 171 

SECTION FIFTH. 

On the diseases of the labyrinth, ----- 173 

Chap. I. On the diseases of the membranes covering the foramina 

rotundum and ovale, ------- #. 

Chap. II. On mal-formation of the foramina rotundum and ovale, 174 
Chap. III. On mal-formation of the labyrinth, - 175 
Chap. IV. On inflammation of the nervous expansion of the laby- 
rinth, 177 

Chap. V. On the degeneration of the liquor of Cotunnus, - - 181 

Chap. VI. On the wasting of the liquor of Cotunnus, - - 182 



228 



SECTION SIXTH. 
On diseases op the acoustic nerve, - 184 

Conclusion, ------'--. 2Q3 



SUPPLEMENT. 

ON DISEASES OP THE EXTERNAL EAiL 

Wounds of the external ear, ....... 206 

Ulceration and sloughing of the external ear from pressure, - 207 

Mal-position of the external ear, ----... 208 

Imperforate condition of the external meatus, - - - - 209 

Foreign bodies in the meatus externus, - - - - - -211 

Indurated wax in the meatus, ------. 213 

Insects in the meatus, .-.-.-..- 214 

Polypus excrescences in the meatus, ----.. 215 

Morbid dryness of the meatus, - - - - - - -216 

Inflammation and abscess of the meatus, ----- 217 

Ulcer of the meatus, - - - - ,.- - - - - 218 

Description of an instrument for perforating the membrana tympani, 223 



THE END. 



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